The final regulations contain a list of programs that comply with the nondiscrimination requirements without having to satisfy any additional requirements (assuming participation in the program is made available to all similarly situated individuals). Such programs are those under which none of the conditions for obtaining a reward is based on an individual satisfying a standard related to a health factor or under which no reward is offered. These include:

• a program that reimburses all or part of the cost for memberships in a fitness center;
• a diagnostic testing program that provides a reward for participation and does not base any part of the reward on outcomes;
• a program that encourages preventive care through the waiver of the copayment or deductible requirement under a group health plan for the costs of, for example, prenatal care or well-baby visits;
• a program that reimburses employees for the costs of smoking cessation programs without regard to whether the employee quits smoking; and
• a program that provides a reward to employees for attending a monthly health education seminar.

Programs subject to additional requirements. If any of the conditions for obtaining a reward under a wellness program is based on an individual satisfying a standard related to a health factor, the wellness program must meet the following five additional requirements.

1. Limited reward. The amount of the reward may not exceed 20 percent of the cost of employee-only coverage under the plan.
2. Reasonable design. The program must be reasonably designed to promote health or prevent disease.
3. Yearly offer. The program must give individuals eligible for the program the opportunity to qualify for the reward under the program at least once per year.
4. Reasonable alternative standard. A reasonable alternative standard for obtaining the reward must be available for individuals for whom, for that period, it is unreasonably difficult due to a medical condition to satisfy, or medically inadvisable to attempt to satisfy, the otherwise applicable standard.
5. Disclosure. All plan materials describing the terms of the program must disclose the availability of a reasonable alternative standard.

Applicability date. The regulations apply for plan years beginning on or after July 1, 2007. Until the applicability date, plans are required to comply with the corresponding sections of the regulations previously published in the Federal Register (66 FR 1378) and other applicable regulations.

Source: 71 FR 75013, December 13, 2006.