Q. Can a midsize employer with a self-funded health plan require participation in the annual biometric screening and engagement with a health coach for one session in order for employees (and possibly spouses) to be eligible to enroll in the employer’s health plan?
A. It is possible to require individuals to complete annual biometric screening and 1 health coaching session as a condition of initial or continued enrollment, but this requires careful calibration and monitoring to ensure the requirement does not run afoul of HIPAA, GINA, and ACA requirements. The biometric screening cannot request or collect genetic information, and individuals cannot be denied eligibility to enroll (or be charged different premiums based) on the results. In other words, the screening must be treated more as an informational questionnaire (collecting background information) and not as a test to be passed or failed. Furthermore, overall plan participation should be monitored for compliance with the ACA requirements so that the employer will not be subject to an employer shared responsibility payment under the ACA.
Alternatively, the biometric screening requirement could be paired with a wellness plan incentive, rather than an eligibility incentive. This would allow a much wider scope of rewards and avoid some of the complications above, though HIPAA would still prohibit a wellness plan from discriminating based on the results of biometric screening or from collecting genetic data.