[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3688 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 3688

    To encourage programs of health promotion or disease prevention.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 1, 2009

Mr. Arcuri (for himself, Mr. Buyer, Mr. Castle, Mr. Polis of Colorado, 
   Mr. Donnelly of Indiana, and Mr. Deal of Georgia) introduced the 
   following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committees on Education and Labor and 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
    To encourage programs of health promotion or disease prevention.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. PROGRAMS OF HEALTH PROMOTION OR DISEASE PREVENTION.

    (a) In General.--Nothing in the Employee Retirement Income Security 
Act of 1974, the Internal Revenue Code of 1986, or the Public Health 
Service Act shall be applied, administered, or interpreted to prevent 
any provider or issuer of health insurance (including any employer) 
from establishing premium discounts or rebates, or modifying copayments 
or deductibles, in the case of individuals who adhere to, or 
participate in, a program of health promotion or disease prevention 
which meets the requirements of subsection (b).
    (b) Programs of Health Promotion or Disease Prevention to Which 
Section Applies.--
            (1) General provisions.--
                    (A) General rule.--For purposes of subsection (a), 
                a program of health promotion or disease prevention 
                (referred to in this subsection as a ``wellness 
                program'') shall be a program that is designed to 
                promote health or prevent disease that meets the 
                applicable requirements of this subsection.
                    (B) No conditions based on health status factor.--
                If none of the conditions for obtaining a premium 
                discount or rebate or other reward for participation in 
                a wellness program is based on an individual satisfying 
                a standard that is related to a health status factor, 
                such wellness program shall not violate this section if 
                participation in the program is made available to all 
                similarly situated individuals and the requirements of 
                paragraph (2) are complied with.
                    (C) Conditions based on health status factor.--If 
                any of the conditions for obtaining a premium discount 
                or rebate or other reward for participation in a 
                wellness program is based on an individual satisfying a 
                standard that is related to a health status factor, 
                such wellness program shall not violate this section if 
                the requirements of paragraph (3) are complied with.
            (2) Wellness programs not subject to requirements.--If none 
        of the conditions for obtaining a premium discount or rebate or 
        other reward under a wellness program as described in paragraph 
        (1)(B) are based on an individual satisfying a standard that is 
        related to a health status factor (or if such a wellness 
        program does not provide such a reward), the wellness program 
        shall not violate this section if participation in the program 
        is made available to all similarly situated individuals. The 
        following programs shall not have to comply with the 
        requirements of paragraph (3) if participation in the program 
        is made available to all similarly situated individuals:
                    (A) A program that reimburses all or part of the 
                cost for memberships 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 encourages preventive care 
                related to a health condition through the waiver of the 
                copayment or deductible requirement under an individual 
                or group health plan for the costs of certain items or 
                services related to a health condition (such as 
                prenatal care or well-baby visits).
                    (D) A program that reimburses individuals for the 
                costs of smoking cessation programs without regard to 
                whether the individual quits smoking.
                    (E) A program that provides a reward to individuals 
                for attending a periodic health education seminar.
            (3) Wellness programs subject to requirements.--If any of 
        the conditions for obtaining a premium discount, rebate, or 
        reward under a wellness program as described in paragraph 
        (1)(C) is based on an individual satisfying a standard that is 
        related to a health status factor, the wellness program shall 
        not violate this section if the following requirements are 
        complied with:
                    (A) The reward for the wellness program, together 
                with the reward for other wellness programs with 
                respect to the plan that requires satisfaction of a 
                standard related to a health status factor, shall not 
                exceed 30 percent of the cost of employee-only coverage 
                under the plan. If, in addition to employees or 
                individuals, any class of dependents (such as spouses 
                or spouses and dependent children) may participate 
                fully in the wellness program, such reward shall not 
                exceed 30 percent of the cost of the coverage in which 
                an employee or individual and any dependents are 
                enrolled. For purposes of this paragraph, the cost of 
                coverage shall be determined based on the total amount 
                of employer and employee contributions for the benefit 
                package under which the employee is (or the employee 
                and any dependents are) receiving coverage. A reward 
                may be in the form of a discount or rebate of a premium 
                or contribution a waiver of all or part of a cost-
                sharing mechanism (such as deductibles, copayments, or 
                coinsurance), the absence of a surcharge, or the value 
                of a benefit that would otherwise not be provided under 
                the plan. The Secretaries of Labor, Health and Human 
                Services, and the Treasury may increase the reward 
                available under this subparagraph to up to 50 percent 
                of the cost of coverage if the Secretaries determine 
                that such an increase is appropriate.
                    (B) The wellness program shall be 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 
                and it is not overly burdensome, is not a subterfuge 
                for discriminating based on a health status factor, and 
                is not highly suspect in the method chosen to promote 
                health or prevent disease. The plan or issuer shall 
                evaluate the program's reasonableness at least once per 
                year.
                    (C) The plan shall give individuals eligible for 
                the program the opportunity to qualify for the reward 
                under the program at least once each year.
                    (D) The full reward under the wellness program 
                shall be made available to all similarly situated 
                individuals. For such purpose, among other things:
                            (i) The reward is not available to all 
                        similarly situated individuals for a period 
                        unless the wellness program allows--
                                    (I) for a reasonable alternative 
                                standard (or waiver of the otherwise 
                                applicable standard) for obtaining the 
                                reward for any individual for whom, for 
                                that period, it is unreasonably 
                                difficult due to a medical condition to 
                                satisfy the otherwise applicable 
                                standard; and
                                    (II) for a reasonable alternative 
                                standard (or waiver of the otherwise 
                                applicable standard) for obtaining the 
                                reward for any individual for whom, for 
                                that period, it is medically 
                                inadvisable to attempt to satisfy the 
                                otherwise applicable standard.
                            (ii) If reasonable under the circumstances, 
                        the plan or issuer may seek verification, such 
                        as a statement from an individual's physician, 
                        that a health status factor makes it 
                        unreasonably difficult or medically inadvisable 
                        for the individual to satisfy or attempt to 
                        satisfy the otherwise applicable standard.
                    (E) The plan or issuer involved shall disclose in 
                all plan materials describing the terms of the wellness 
                program the availability of a reasonable alternative 
                standard (or the possibility of waiver of the otherwise 
                applicable standard) required under subparagraph (D). 
                If plan materials disclose that such a program is 
                available, without describing its terms, the disclosure 
                under this subparagraph shall not be required.
    (c) Existing Programs.--Nothing in this section shall prohibit a 
program of health promotion or disease prevention that was established 
prior to the date of enactment of this section and applied with all 
applicable regulations, and that is operating on such date, from 
continuing to be carried out for as long as such regulations remain in 
effect.
    (d) Regulations.--Nothing in this section shall be construed as 
prohibiting the Secretaries of Labor, Health and Human Services, or the 
Treasury from promulgating regulations in connection with this section.
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