October 2009 Bulletin, "GINA Regulations Require Redesign of Health Plan Wellness and Disease Management Incentives"

Abstract

On October 7, 2009, the federal agencies responsible for implementing the group health plan provisions of the Genetic Information Nondiscrimination Act of 2008 (GINA) published interim final regulations that provide guidance on how the law affects incentives in wellness and disease management programs. The regulations apply to plan years beginning on or after December 7, 2009 (for calendar years plans, as of January 1, 2010) and will require immediate action by plan sponsors.

The Bulletin provides an overview of GINA's prohibitions; discusses the regulations involved in using health-risk assessments to ask questions about an individual's family medical history; and briefly outlines the action steps for sponsors of group health plans. 

Plan sponsors must conduct a compliance review immediately to ensure that:

  • Health-risk assessments (including those designed by outside vendors) and any associated wellness policies and procedures comply with GINA's broad prohibition on collecting genetic information; and
  • Wellness or disease management programs do not collect or use genetic information to screen individuals for eligibility for benefits under the plan. 

After the initial compliance review is finished, it will be important to revisit the goals of a wellness or disease management program and assure that it is designed in a way that best accomplishes the needs of the plan participants. This could include readjusting plan incentives or targeting them to specific issues that affect the plan's population.

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