When Are Employee Wellness Incentives No Longer Voluntary? : Shots - Health News Many workers like the programs, and employers say they help hold down health insurance costs. But there are legal questions about how far companies can go to encourage participation.
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When Are Employee Wellness Incentives No Longer Voluntary?

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When Are Employee Wellness Incentives No Longer Voluntary?

When Are Employee Wellness Incentives No Longer Voluntary?

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Most medium-to-large employers offer some sort of wellness program for their workers. That can range from health screenings to weight loss and smoking cessation programs. Many employees like these options and employers like that they can help hold down health insurance costs. But there are legal questions about how far employers can go to encourage participation. NPR's Yuki Noguchi has this story.

YUKI NOGUCHI, BYLINE: Scotts Miracle-Gro makes products for the care and health of lawns. The Marysville, Ohio company says it wants to nurture its 8,000 employees the same way.

JIM KING: It's very much of a family culture here.

NOGUCHI: Jim King is a spokesman for the Scotts company, which offers discounted prescriptions, annual health screenings and some free medical care. In states where it's legal, it refuses to hire people who smoke.

KING: We've been screening for tobacco use for about a decade. We no longer employ tobacco users.

NOGUCHI: That provision landed the company in court several years ago. A new hire failed a urine test for nicotine, lost his job offer and sued the company, arguing it was meddling in private affairs in order to drive down costs. He lost on appeal in 2012. About 80 percent of Scotts employees submit to health screenings, and those who make unhealthy choices pay more for health insurance. King says Scotts wellness policy attracted outside scrutiny, but employees embrace it.

KING: Once people understood what the program actually was, they recognized that it wasn't anything like Big Brother at all, and in fact, what we were doing was providing them tools.

NOGUCHI: Participation in the wellness program at Scotts is not mandatory. In fact, under the law, such programs must be voluntary. But regulators are now trying to define what voluntary means. Some hospitals require their workers get flu shots, which is controversial among those who can't or don't want to get vaccines. Beyond that, there are questions about money. For example, is a big financial penalty for non-participation too coercive? What about incentives for completing health screenings? Nico Pronk is chief science officer at HealthPartners, a hospital system. He researches the effectiveness of wellness programs and says their design matters. He says incentives can work, but you have to be careful not to overdo it.

NICO PRONK: Once the incentives amounts go over a certain threshold, it may become a little bit more coercive.

NOGUCHI: Last year, the Equal Employment Opportunity Commission sued several companies, alleging their policies were too heavy-handed. They argue those companies required health screenings or made non-participants bear the full cost of health insurance. Christopher Kuczynski is associate legal counsel at the EEOC. He notes that in a separate proceeding, the commission is considering regulations to define what companies are allowed to do to encourage participation in wellness programs.

CHRISTOPHER KUCZYNSKI: Limited incentives are permissible as long as the maximum incentive for participating doesn't exceed 30 percent of the total cost of coverage.

NOGUCHI: Kuczynski says employers must make sure their programs comply with many laws, including health and genetic information privacy, the Affordable Care Act and the Americans with Disabilities Act. Employers can't use a worker's health against them.

KUCZYNSKI: There are opportunities for discrimination. This information that's collected as part of a wellness program can't cross over to anyone who deals with making employment decisions.

NOGUCHI: Business groups say they are striking a balance between encouraging participation and protecting the choice of their workers. Brian Marcotte is president and CEO of National Business Group on Health, a policy group representing large employers. He says most health care costs are lifestyle-related, and employers want to reduce costs, but that's not the only calculation companies are making.

BRIAN MARCOTTE: At the end of the day, employers want healthy, productive, engaged, resilient employees and the most competitive workforce possible. And investments in health and well-being are part of that equation.

NOGUCHI: Nancy Hammer is government affairs counsel for the Society for Human Resource Management. She says employers want to draw in, not compel workers.

NANCY HAMMER: Health care and wellness is an employee benefit. So you've got to do something that is attractive to your employees.

NOGUCHI: No one benefits, she says, if no one uses the programs. Yuki Noguchi, NPR News, Washington.

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