General Provisions Applicable to Wellness Programs

(a) Wellness programs as set out in this subchapter are excepted from the general prohibitions against discrimination based on a health status-related factor for plan provisions that vary benefits, including cost-sharing mechanisms, or the premium or contribution for individuals eligible for plan coverage, in connection with participation in such a wellness program.

(b) A wellness program must be reasonably designed to promote disease prevention, wellness, and health. A program satisfies this standard if it:

(1) has a reasonable probability of improving the health of, or preventing disease in, participating individuals;

(2) is not overly burdensome;

(3) is not a subterfuge for otherwise prohibited discrimination based on a health status-related factor; and

(4) is not highly suspect in the method chosen to promote disease prevention, wellness, and health.

(c) A wellness program must comply, as applicable, with Insurance Code §1701.061 and provisions of rules codified in this title relating to Insurance Code §1701.061 and the administration of noninsurance benefits.

Source Note: The provisions of this §21.4705 adopted to be effective March 31, 2009, 34 TexReg 2135; amended to be effective July 22, 2015, 40 TexReg 4693.