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This entry was published on 2017-01-20
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Wellness programs
Insurance (ISC) CHAPTER 28, ARTICLE 32
§ 3239. Wellness programs. (a) An insurer licensed to write accident
and health insurance, a corporation organized pursuant to article
forty-three of this chapter, a health maintenance organization certified
pursuant to article forty-four of the public health law and a municipal
cooperative health benefits plan may establish a wellness program in
conjunction with its issuance of a group accident and health insurance
policy or group subscriber contract. A "wellness program" is a program
designed to promote health and prevent disease that may contain rewards
and incentives for participation. Participation in the wellness program
shall be available to similarly-situated members of the group and shall
be voluntary on the part of the member. The terms of the wellness
program shall be set forth in the policy or contract.

(b) A wellness program may include, but is not limited to, the
following programs or services:

(1) the use of a health risk assessment tool;

(2) a smoking cessation program;

(3) a weight management program;

(4) a stress and/or hypertension management program;

(5) a worker injury prevention program;

(6) a nutrition education program;

(7) health or fitness incentive programs;

(8) a coordinated weight management, nutrition, stress management and
physical fitness program to combat the high incidence of adult and
childhood obesity, asthma and other chronic respiratory conditions;

(9) a substance or alcohol abuse cessation program; and

(10) a program to manage and cope with chronic pain.

(c)(1) A wellness program may use rewards and incentives for
participation provided that where the group health insurance policy or
subscriber contract is required to be community-rated, the rewards and
incentives shall not include a discounted premium rate or a rebate or
refund of premium.

(2) Permissible rewards and incentives may include:

(A) full or partial reimbursement of the cost of participating in
smoking cessation, weight management, stress and/or hypertension, worker
injury prevention, nutrition education, substance or alcohol abuse
cessation, or chronic pain management and coping programs;

(B) full or partial reimbursement of the cost of membership in a
health club or fitness center;

(C) the waiver or reduction of copayments, coinsurance and deductibles
for preventive services covered under the group policy or subscriber

(D) monetary rewards in the form of gift cards or gift certificates,
so long as the recipient of the reward is encouraged to use the reward
for a product or a service that promotes good health, such as healthy
cook books, over the counter vitamins or exercise equipment;

(E) full or partial reimbursement of the cost of participating in a
stress management program or activity; and

(F) full or partial reimbursement of the cost of participating in a
health or fitness program.

(3) Where the reward involves a group member's meeting a specified
standard based on a health condition, the wellness program must meet the
requirements of 45 CFR Part 146.

(4) A reward or incentive which involves a discounted premium rate or
a rebate or refund of premium shall be based on actuarial demonstration
that the wellness program can reasonably be expected to result in the
overall good health and well being of the group.