WebMD Health (WBMD)

 

Certain provisions of HIPAA (commonly referred to as the HIPAA nondiscrimination provisions) generally prohibit group health plans from charging similarly situated individuals different premiums or contributions or imposing different deductible, co-payment, or other cost-sharing requirements based on a “health factor.” Such differentials are, however, acceptable under the HIPAA nondiscrimination provisions if the differentials are applied through “wellness programs.” The Department of Labor, in coordination with the Department of the Treasury and HHS, has issued regulations that define “wellness programs” for purposes of the HIPAA nondiscrimination provisions, establishing specific requirements for wellness programs that reward participants who satisfy a standard related to a health factor. These requirements include (1) limiting the amount of the wellness program’s rewards, (2) the wellness program being designed to promote good health and prevent disease, (3) giving those eligible to participate in the wellness program the opportunity to qualify for the reward at least once a year, (4) providing a reward that’s available to all similarly situated individuals, and (5) requiring disclosure of reasonable alternative standards that must be available under the wellness program.

 

Although HIPAA and its regulations state that certain excepted benefits, including supplemental benefits, are not subject to the wellness program rules, it does not define the term “similar supplemental coverage.” On December 7, 2007, the Department of Labor, in coordination with the Department of the Treasury and HHS, released Field Assistance Bulletin No. 2007-04 (FAB 2007-04) in response to the development of questionable health and wellness programs that were marketed as “similar supplemental coverage.” FAB 2007-04 clarifies the rules for supplemental programs and provides that supplemental benefits under a wellness program cannot discriminate on the basis of a health factor. With these new requirements in place, wellness programs that require individuals to meet certain health factors can no longer be considered supplemental and thus have to comply with HIPAA wellness program regulations described in the immediately preceding paragraph. According to FAB 2007-04, programs that do not meet these requirements may be subject to enforcement actions.

 

We provide certain services related to wellness programs as part of our private portals business. See “Our Online Services — Our Private Portals: WebMD Health Services” above. We believe that we are in compliance with the laws and regulations applicable to these services.

 

The HIPAA nondiscrimination provisions generally prohibit group health plans from charging similarly situated individuals different premiums or contributions or imposing different deductible, co-payment, or other cost-sharing requirements based on a “health factor.” There is, however, an exception that allows plans to offer wellness programs. WebMD provides certain services related to wellness programs as part of its private portals business. The Final Rules on Nondiscrimination and Wellness Programs in Health Coverage in the Group Market, which were issued December 13, 2006, establish five requirements for wellness programs that reward participants who satisfy a standard related to a health factor. These rules are generally effective for the plan year starting on or after July 1, 2007.

 

Although HIPAA states that certain excepted benefits, including supplemental benefits, are not subject to the wellness program rules, it does not define the term “similar supplemental coverage.” On December 7, 2007, the Department of Labor, in coordination with the Departments of the Treasury and HHS, released Field Assistance Bulletin No. 2007-04 (FAB 2007-04) in response to the development of questionable wellness programs that were marketed as “supplemental” benefits. FAB 2007-04 clarifies the rules for supplemental programs and states that supplemental benefits under a wellness program cannot discriminate on the basis of a health factor.

 

With these new requirements in place, wellness programs that require individuals to meet certain health factors can no longer be considered supplemental and thus have to comply with HIPAA wellness rules. According to FAB 2007-04, programs that do not meet these requirements may be subject to enforcement actions. We believe that we are in compliance with any applicable law or regulation when we run these types of programs for our private portals customers.

 

 

The HIPAA nondiscrimination provisions generally prohibit group
health plans from charging similarly situated individuals
different premiums or contributions or imposing different
deductible, co-payment, or other cost-sharing requirements based
on a “health factor.” There is, however, an exception
that allows plans to offer wellness programs. WebMD provides
certain services related to wellness programs as part of its
private portals business. The Final Rules on Nondiscrimination
and Wellness Programs in Health Coverage in the Group Market,
which were issued December 13, 2006, establish five
requirements for wellness programs that reward participants who
satisfy a standard related to a health factor. These rules are
generally effective for the plan year starting on or after
July 1, 2007.

 

Although HIPAA states that certain excepted benefits, including
supplemental benefits, are not subject to the wellness program
rules, it does not define the term “similar supplemental
coverage.” On December 7, 2007, the Department of
Labor, in coordination with the Departments of the Treasury and
HHS, released Field Assistance
Bulletin No. 2007-04
(FAB
2007-04) in
response to the development of questionable wellness programs
that were marketed as “supplemental” benefits. FAB
2007-04
clarifies the rules for supplemental programs and states that
supplemental benefits under a wellness program cannot
discriminate on the basis of a health factor.

 

With these new requirements in place, wellness programs that
require individuals to meet certain health factors can no longer
be considered supplemental and thus have to comply with HIPAA
wellness rules. According to FAB
2007-04,
programs that do not meet these requirements may be subject to
enforcement actions. We believe that we are in compliance with
any applicable law or regulation when we run these types of
programs for our private portals customers.