Wellness Programs With Participation as Sole Basis for Reward Eligibility

(a) A wellness program that contains no condition for obtaining a reward premised on an individual satisfying a standard associated with a health factor does not violate this subchapter so long as the status-related program is made available to all individuals eligible for coverage under the plan.

(b) Wellness programs meeting the description of this section would include the following program types:

(1) a program that reimburses all or part of the cost for membership in a fitness center;

(2) a diagnostic testing program that provides a reward for participation and does not base any part of the reward on testing outcomes;

(3) a program that encourages preventive care through the waiver of the copayment or deductible requirement under a group health plan or individual policy for the costs of a particular preventive care item or items;

(4) a program that reimburses covered individuals for the costs of smoking cessation programs without regard to whether the individual quits smoking; or

(5) a program that provides a reward to covered individuals for attending a monthly health education seminar.

Source Note: The provisions of this §21.4706 adopted to be effective March 31, 2009, 34 TexReg 2135; amended to be effective July 22, 2015, 40 TexReg 4693.