Health and Wellness Plan Compliance

Health and wellness plans must comply with several major laws and regulations issued by the Internal Revenue Service (IRS), the Department of Labor (DOL), and the Equal Employment Opportunity Commission (EEOC). Not only must they comply with (or be exempt from) health reform rules, they must comply with:

  • Health Insurance Portability and Accountability Act (HIPAA) Nondiscrimination Rules, including the final wellness regulations issued on those rules
  • HIPAA Privacy Rules for self-funded health plans
  • EEOC guidance and regulations (particularly those on wellness)
  • Genetic Information Nondiscrimination Act (GINA) Rules
  • Family and Medical Leave Act (FMLA) Rules
  • Employee Retirement Income Security Act (ERISA) Form 5500 reporting requirements
  • Title VII Nondiscrimination on age, disability and/or gender

Frost Brown Todd advises employers on required compliance for wellness programs, including whether a wellness program is an ERISA plan and which other compliance requirements apply. We are also seeing increased interest in on-site clinics and other approaches to reducing overall health care costs. These programs can also have significant compliance obligations. Often, cost-savings programs can be very effective and create significant cost savings, making it worthwhile to incur the expense for compliance. We work with employers and their brokers and consultants to help design programs that meet the employer's goals while limiting risk.