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In a historic decision by the Supreme Court on June 26th, same-sex marriage is now legal across America. While the LGBT community rejoices with pride parades and the use of #LoveWins on social media, this ruling could have another impact on the health insurance industry in our country. 

The ruling, in conjunction with the Affordable Care Act, makes it now possible for gay and lesbian employees to add their spouses to their company-provided health insurance plan. Also, insurance companies are now mandated to offer the same individual and group health plans to legally married same-sex couples.

While these effects address constitutional questions, some still have unanswered logistical questions. 

Read more on Modern Healthcare's "Same-sex marriage ruling puts health benefits in spotlight" article by Lisa Schencker and Bob Herman.

With yesterday’s ruling, the Supreme Court once again upheld ObamaCare and with it the compliance nightmares.

The compliance web can be daunting and at times feel like a moving target. You have to comply with EEOC, ADA, HSA regulations, the Cadillac tax, non-discrimination rules, affordability guidelines; the list continues and is almost endless.

The good news is there is a solution. BeniComp’s products are excepted benefits and as such are exempt. The even better news, is you are protected.

For more information on BeniComp products, please visit our solutions page at www.benicomp.com/products

Employers have had to watch every step they take for fear that any misstep will result in a huge blow up. The ability for employers to effectively incentivize their employees to a healthier lifestyle really now lays in the knowledge that a third party vendor must administer the wellness plan if any variable incentives would be offered. And, as has been proven, the outcome-based incentives are what produce a positive change. Lifestyle improvements equal reduction in trend, increased presenteeism, employee health and wellbeing, and overall ROI.

If employer sponsored wellness programs are a minefield, then the latest rules have just detonated a few grenades. Outcomes-based wellness programs produce ROI. Plans with no incentives expect 20-30% total participation, which usually end up being the healthy employees. This kind of turnout gives smoking cessation tools or diabetic tools to the wrong people. It’s not the healthy that need a doctor but the sick.

Incentives can boost engagement to 60-70%, or 90-95% if well thought out. Higher participation provides ROI and early detection because the right tools are in the right hands. And to the employer, the wellness world finally makes sense. Their goal of providing employees with continued access to affordable health care coverage is accomplished for yet another year, right? Well not so fast…

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Steep Penalties for Not Participating Said to Make Program Involuntary
and Violate Disabilities Act

MILWAUKEE -- Manitowoc, Wis.-based Orion Energy Systems violated federal law by requiring an employee to submit to medical exams and inquiries that were not job-related and consistent with business necessity as part of a so-called "wellness program," which was not voluntary, and then by firing the employee when she objected to the program, the U.S. Equal Employment Opportunity Commission (EEOC) charged in a lawsuit it filed today. 

In a lawsuit filed in Green Bay, Wis., today, the federal agency contends that Orion instituted a wellness program that required medical examinations and made disability-related inquiries.  When employee Wendy Schobert declined to participate in the program, Orion shifted responsibility for payment of the entire premium for her employee health benefits from Orion to Schobert.  Shortly thereafter, Orion fired Schobert.  

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The Equal Employment Opportunity Commission (EEOC) issued final rules describing their interpretation of what employers are able to do to encourage employee participation in employer-sponsored wellness programs, while still complying with the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). However, the new rules come during legal battles about whether the commission's interpretation is even correct.

In an interview with Cook County Record, Mark Casciari, a partner with Seyfarth Shaw LLP said “The EEOC now has issued wellness regulations under the ADA and GINA, but they're being challenged in court.” Casciari went on to point out that "Barbara Crabb [the district court judge] said the EEOC's reading of the Americans with Disabilities Act is wrong and not consistent with the statute, which undermines the regulations.”

At a time critical time in history when health insurance has risen drastically, and many Americans have adopted unhealthy lifestyles creating additional health risks, employers are looking for answers. “There are a lot of employers who think wellness is good and that health risk assessments are good, that biometric screening is good, and that people should know about their risks so they can change their behavior and reduce health expenses,” Cascari said. “If you take away wellness incentives, which the EEOC would want you to do in substantial part, it may be counter-productive in promoting wellness.”

Historically, wellness programs comply with regulations under the Affordable Care Act (ACA) and the Health Insurance Portability and Accountability Act (HIPAA). Cascari noted that following those already settled regulations is important for employers to protect themselves. Cascari stated, “When it comes to the EEOC, the question is whether any litigation from the EEOC about non-compliance with the regulations will continue to be unsuccessful. If the employer wants to reduce all risk of EEOC litigation, it could comply with the EEOC regulations. On the other hand, the EEOC regulations could be illegal, so you may unnecessarily be complying.”

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