Clarification on Limits for Wellness Program Incentives Under ADA and GINA

By David Pixley

Under the current ADA and the GINA regulations, incentives for participation in wellness programs are limited to 30% of self-only coverage for the lowest cost group health plan offered by an employer. For purposes of these regulations, when an employer offers its employees, “…more than one group health plan and enrollment in a particular plan is not required to participate in a wellness program that collects health information, the incentive limit is calculated using the total cost of the lowest cost self-only coverage under a major medical group health plan.”

Recently, the EEOC Office of Counsel staff members published a letter in response to a comment from a federal agency. The commenter inquired as to whether these same incentive limits applied to an employer offering only one group health plan, but multiple benefit options. According to the EEOC Office of Counsel, the incentive limits are the same for an employer that offers multiple plans as for an employer that offers one group health plan with multiple benefit options.

For example, if an employer offered one group health plan with three benefit options (gold, silver, and bronze) the incentive for participation in the wellness program would be limited to the lowest cost option. The gold option being $600 per month, the silver option being $400 per month, and the bronze option being $200 per month for self-only coverage. Because the lowest cost option for self-only coverage is the $200 bronze option, the maximum incentive that the employer could offer is 30% of $200, or $60.00. Therefore, for an employee that elects the $600 gold option or the $400 silver option, the maximum incentive the employer may offer for participation in its wellness program is only $60.

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