Migliaccio & Rathod LLP is investigating employer wellness programs that require employees to meet particular health targets—such as a certain BMI, blood-pressure level, cholesterol level, glucose level, or wellness score—in order to receive lower health-insurance premiums or other health-plan benefits.
These programs are different from wellness programs that simply ask an employee to participate. Under an outcome-based program, the employee must actually achieve or maintain a specified health result.
Federal wellness-program rules generally require outcome-based programs to provide employees who do not meet the original health standard with another way to earn the full reward. The alternative generally cannot simply require the employee to achieve another health outcome.
Examples of Programs We Are Reviewing
Migliaccio & Rathod LLP is reviewing wellness programs that may include health-outcome requirements, including:
- JPMorgan Chase, whose public materials have described wellness rewards associated with BMI and blood-pressure outcomes;
- employers using programs that require employees to achieve a specified wellness score or “healthy range”;
- employers combining biometric results with points-based wellness programs; and
- other plans that condition premium discounts or HSA contributions on measurable health outcomes.
The inclusion of an employer or program on this page does not mean that the program violates the law. We are investigating whether employees who did not meet health targets were offered the alternatives and protections required by law.
You May Be Affected If:
- You receive health insurance through a private-sector employer;
- Your wellness program measured BMI, weight, blood pressure, cholesterol, blood sugar, or another health marker;
- You had to fall within a particular “healthy” range to receive the full premium discount;
- You had to earn a particular wellness score or number of points;
- You failed to meet the target and lost some or all of a premium discount or HSA contribution;
- You were told that an alternative was available only if you were medically unable to meet the target;
- You were required to obtain a doctor’s certification before receiving an alternative;
- you completed an alternative but received only future discounts rather than the full available reward; or
- you were never told that another way to qualify existed.
Public materials from some employers show that biometrics, health assessments, and wellness points can be tied to substantial annual financial incentives. For example, Nebraska Medicine materials describe premium or HSA incentives involving surveys, screenings, wellness points, and spouse participation.
What Should You Look For?
Potentially important language in your employer’s SPD or benefits materials may include:
- “healthy outcomes credit”;
- “BMI target”;
- “healthy range”;
- “know your numbers”;
- “wellness points required”;
- “biometric screening incentive”; or
- language stating that you must meet a health target to receive lower premiums or an employer contribution.
Does This Apply to Your Health Plan?
This investigation generally concerns health coverage received through a private-sector employer.
Both self-funded employer plans and plans insured through an insurance company may qualify. Government employee plans and certain church plans generally do not.
If you do not know what type of plan you have, you do not need to determine that yourself. We can often identify the plan from your SPD, insurance card, open-enrollment materials, or employer benefits documents.
If you lost a wellness discount or health-plan contribution because you did not meet a BMI, blood-pressure, cholesterol, glucose, wellness-score, or other health target, we would like to hear from you.
There is no charge to speak with us, and there is no obligation to take legal action.
Please complete the contact form on this page, send us an email at [email protected], or call us at (202) 470-3520.
Migliaccio & Rathod LLP is a Washington, D.C.-based law firm that represents employees and consumers in class-action litigation nationwide.