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May 24, 2018

Direct-to-Employer Wellness Programs: Promising but Complex

This Briefing is brought to you by AHLA's Labor and Employment; Health Information and Technology; and Payers, Plans, and Managed Care Practice Groups.
  • May 24, 2018
  • Paul A. Gomez , Polsinelli LLP , Los Angeles, CA
  • Anthony H. Choe , Polsinelli PC , Washington, DC

For decades, employers have offered health care benefits focused on coverage for medical services and items, made available through group health plans offered by contracted full-risk insurers or through self-funded health benefit options offered by employers. Although health insurers have traditionally offered wellness programs in connection with their group health plan offerings, employers are increasingly engaging non-insurer vendors to establish their own wellness programs. However, legal challenges have clouded the future of certain key features common in such programs.

Increasingly, vendors are offering wellness program services without fully appreciating the scope of federal legal requirements applicable to both the employers and the vendors. As such, vendors not only invite risk to themselves, but also to their clients with respect to federal anti-discrimination and data privacy laws, as well as other compliance obligations. Vendors must also be prepared to adjust to the shifting regulatory landscape as court decisions and ongoing agency rulemaking continue to alter the standards for these programs.

In order to effectively advise clients on how to design, implement, and market wellness program services to employers, and on key reimbursement and structuring issues, health care attorneys must understand the wide array of legal requirements applicable to wellness programs, which remains an active area for legislation, rulemaking, and litigation. This briefing seeks to provide guidance on the issues, benefits, and risks of engaging non-insurer vendors to offer such programs.

Read this briefing.

AHLA thanks Paul A. Gomez (Polsinelli PC, Los Angeles, CA) and Anthony H. Choe (Polsinelli PC, Washington, DC) for authoring this Briefing.

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