Florida Governor Rick Scott Signs CS/CS/HB 445, which expressly states that the incentives and rewards offered to enrollees in wellness or health improvement programs do not constitute unfair methods of competition or deceptive acts or practices and thus do not violate s. 626.9541, F.S., or s. 641.3903, F.S.
Florida Governor Rick Scott signed CS/CS/HB 445 on Friday, June 17, 2011. The bill, effective July 1, 2011, permits group or individual health insurers and HMOs to offer a voluntary health or wellness improvement program to those insured. The bill also permits rewards and incentives to be offered for participation in the program. Those rewards and incentives may include, but are not limited to, merchandise, premium discounts or rebates, and modifications to copayment, deductible, or coinsurance amounts.
CS/CS/HB 445 allows insurers and HMOs to request verification of a member’s inability to participate in a voluntary health or wellness improvement program due to a medical condition. Verification may be in the form of a statement from the member’s treating physician concluding that it is difficult or inadvisable for the member to participate in a health or wellness improvement program.
The Health Insurance Portability and Accountability Act of 1996 generally prohibits group health plans from charging similarly situated individuals different premiums, or requiring other additional payments on the basis of a health factor. An exception exists for plans that offer rewards or incentives for member participation in health or wellness programs under specified circumstances.
Health insurers and health maintenance organizations (HMOs) are permitted to provide for a rebate of premiums paid on an individual health insurance policy when a covered individual enrolls in and maintains participation in a health wellness, maintenance or improvement program approved by the insurer. The premium rebate is effective for the covered individual on an annual basis.
For group health plans, a rebate of premiums paid during the preceding year is provided to members of the plan when the majority of members have enrolled in and maintained participation in any health wellness, maintenance, or improvement program offered by the group policyholder and health plan.
Evidence of maintenance or improvement of the enrollees’ health status is achieved through assessment of health status indicators.
Florida law previously allowed insurers are permitted to provide for a rebate of premiums paid on an individual health insurance policy when a covered individual enrolled in and maintained participation in a health wellness, maintenance or improvement program approved by the insurer. To qualify for any rebate offered by the insurer, a covered individual would have to provide evidence of improvement in his or her health status. The measurement of improvement in health status is accomplished by assessing health status indicators, agreed upon in advance by the individual and the insurer, such as weight loss, decrease in body mass index, and smoking cessation. The premium rebate was effective for the covered individual on an annual basis, unless the individual fails to maintain his or her health status while participating in the wellness program, or evidence shows that the individual is no longer enrolled in the approved wellness program.
To encourage participation in the wellness or health improvement program, CS/CS/HB 445 will now permit a health insurer or an HMO to offer incentives or rewards, such as merchandise, premium rebates or savings, or modifications to copayment, deductible, or coinsurance amounts.
The bill does not limit other forms of incentives or rewards that may be offered to health plan members for adherence to a wellness or health improvement program that may otherwise be available by state or federal law. The bill expressly states that the incentives and rewards offered to enrollees in wellness or health improvement programs do not constitute unfair methods of competition or deceptive acts or practices and do not, therefore, violate s. 626.9541, F.S., or s. 641.3903, F.S.
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