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Wellness Program Requirements 

Wellness programs offered as part of a group health plan must generally comply with the following nondiscrimination, notice, and privacy protection requirements under HIPAA, as amended by the Affordable Care Act (ACA).  

Nondiscrimination Requirements

If a wellness program is part of a group health plan, it must comply with rules created by HIPAA that prevent the employee from being impermissibly discriminated against based on a health factor. "Health factors" include:

  • Health status;
  • Medical condition, including both physical and mental illnesses;
  • Claims experience;
  • Receipt of health care;
  • Medical history;
  • Genetic information;
  • Evidence of insurability; or
  • Disability.

Participatory wellness programs are deemed nondiscriminatory under HIPAA as long as they are made available to all "similarly situated individuals." HIPAA states that plans may distinguish among employees only on "bona fide employment-based classifications" consistent with the employer's usual business practice. For example, the following employees can be treated as different groups of similarly situated individuals:

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