When a wellness program is offered as part of a group health plan, it is subject to HIPAA regulations. This means that any protected health information (PHI) collected from participants, such as data from biometric screenings or health assessments, is protected under HIPAA's Privacy and Security Rules.
How does HIPAA apply to wellness programs offered as part of a group health plan?
A Journal of Managed Care Pharmacy study provides insight into the function of HIPAA, “Lawmakers sought to improve the efficiency and effectiveness of the health care system by encouraging the development of national standards and requirements for electronic transmissions of health information among health care providers, insurance companies, and other health care payers.”
Employers have to incorporate wellness programs into their group health plan's summary plan description (SPD) to ensure transparency and compliance. It includes explaining how PHI will be used and protected within the program. Employers also have to ensure that any vendors or contractors involved in the wellness program, like those conducting biometric screenings, comply with HIPAA standards through business associate agreements (BAAs).
The Affordable Care Act (ACA) clarifies HIPAA's nondiscrimination rules for wellness programs. The ACA allows for two types of wellness programs: participatory and health-contingent. Participatory wellness programs are generally available to all participants without requiring them to meet specific health standards, while health-contingent programs require participants to meet health-related standards to receive rewards.
The types of programs subject to HIPAA
- Healthcare provider programs: Programs run by hospitals, clinics, doctors, and other healthcare providers that electronically transmit health information are subject to HIPAA.
- Health plan programs: Programs offered by health insurance companies, HMOs, employer-sponsored health plans, and government programs like Medicare and Medicaid are subject to HIPAA.
- Healthcare clearinghouse programs: Programs that process nonstandard health information into standard formats are subject to HIPAA.
- Group health plan wellness programs: Wellness programs that are part of a group health plan must comply with HIPAA regulations.
- Research programs: Clinical research programs conducted by healthcare providers that electronically transmit health information are subject to HIPAA.
How to ensure compliance in wellness programs
- Regularly review wellness programs against current legal standards to ensure compliance with laws like HIPAA, ADA, and GINA.
- Protect PHI collected from participants by implementing HIPAA privacy and security measures.
- Design programs to ensure participation is voluntary and not coercive, as required by the ADA.
- Provide reasonable alternatives for employees who cannot participate in certain wellness activities due to health or disability reasons.
- Clearly communicate program objectives, benefits, and requirements to participants.
- Provide training for staff on handling sensitive health information and non-discrimination practices.
- Incorporate wellness programs into group health plans and update SPDs accordingly.
Related: HIPAA Compliant Email: The Definitive Guide
FAQs
Do corporate wellness programs that are not part of a group health plan need to comply with HIPAA?
No, corporate wellness programs that are not part of a group health plan do not need to comply with HIPAA. HIPAA applies to wellness programs only when they are offered as part of a group health plan.
What documentation is required for wellness programs under HIPAA?
Employers must update their summary plan descriptions (SPDs) to include wellness programs if they are part of a group health plan.
How do business associate agreements (BAAs) apply to wellness programs?
If a wellness program vendor handles PHI, a BAA should be entered into to ensure compliance with HIPAA standards
Kirsten Peremore
