1367.007.
(a) A health care service plan shall not offer a wellness program in connection with a group health care service plan contract, or offer an incentive or reward under a group health care service plan contract based on adherence to a wellness program, unless all of the following requirements are satisfied:(1) The program is reasonably designed to promote health or prevent disease. A program complies with the preceding sentence if the program has a reasonable chance of improving the health of, or preventing disease in, participating individuals, is not overly burdensome, is not a subterfuge for discrimination based on a health status factor, does not lead to cost shifting from employer to employee, and is not highly suspect in the method chosen to promote health or prevent disease.
(2) (A) A financial incentive or reward linked to a premium, deductible, copayment, coinsurance, or other cost sharing paid by enrollees is permitted only for participation-based programs. A financial penalty is not permitted.
(B) The total amount of incentives linked to the share of a premium, deductible, copayment, coinsurance, or other cost sharing paid by the enrollee shall not exceed three hundred fifty dollars ($350) annually. This amount shall be adjusted annually in a manner consistent with Section 1302(c)(4) of the federal Patient Protection and Affordable Care Act (42 U.S.C. 18022(c)(4)).
(3) The program may use incentives or rewards for participation that reduce the employee share of premium as long as the employee share of premium does not exceed 50 percent of the premium charged to the group. The employee share of premium shall not vary based on a health outcome or other health status factor.
(4) The program may use incentives or rewards that reduce costs to enrollees, including reductions in premiums, deductibles, copayments, coinsurance, or other cost sharing, as long as the amount does not exceed 20 percent of the original cost without the incentive or reward.
(5) Participation in the program is voluntary.
(6) Receipt of an incentive or reward for participation in the program is not conditioned on an individual satisfying a standard that is related to a health status factor. Wellness programs, including, but not limited to, the following, shall be deemed to satisfy this paragraph:
(A) A program that reimburses all or part of the cost for membership in a fitness center.
(B) A diagnostic testing program that provides a reward for participation and does not base any part of the reward on outcomes.
(C) A program that provides a reward to individuals for attending a periodic health education seminar, so long as the reward is not contingent on a health outcome or other health status factor.
(7) Participation in the program is offered to all similarly situated individuals.
(8) Reasonable accommodation is provided for individuals with disabilities who seek to voluntarily participate in the program.
(9) A reasonably available and equivalent alternative is provided to those individuals who seek to voluntarily participate in the program but are unable to participate due to occupational requirements, a medical condition, or other hardship.
(10) All materials related to the program disclose the availability of the accommodations under paragraphs (8) and (9).
(11) The program assesses the cultural competency needs of the health care service plan’s population in its design.
(12) The program provides language assistance for limited English-speaking individuals.
(13) The program does not result in any decrease in benefits coverage.
(14) The plan reports to the department two years after implementation of the wellness program and every year thereafter, demonstrating reasonable effectiveness of the program in terms of improving health of participants and reducing costs, as determined by the department.
(15) The incentive or reward does not exceed the percentage of the cost of coverage under the plan contract identified in Section 2705(j)(3)(A) of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-4(j)(3)(A)) or regulations adopted thereunder.
(b) Nothing in this section shall prohibit a wellness program that was established prior to January 1, 2014, and applied consistent with all applicable laws in effect immediately prior to that date, and that is operating immediately prior to that date, from continuing to operate.
(c) By March 1, 2019, the department shall submit a report to the appropriate policy committees of the Legislature on the operation of health care service plan-based wellness programs.
(d) For purposes of this section, “wellness program” means a program that is designed to promote health or prevent disease.
(e) This section shall remain in effect only until January 1, 2020, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2020, deletes or extends that date.