                                 CODE OF VIRGINIA

WELLNESS PROGRAMS (§ 38.2-3454)

A. A health carrier offering a health benefit plan providing group health
insurance coverage may provide for a wellness program if such program is made
available to all similarly situated individuals. A wellness program may include:

   1. A program that reimburses all or part of the cost for membership to a
   fitness center;

   2. A diagnostic testing program that provides a reward for participation and
   does not base any part of the reward on outcomes;

   3. A program that encourages preventive care related to a health condition
   through the waiver of the copayment or deductible requirement under a group
   health plan for the cost of certain items or services related to a health
   condition, such as prenatal care or well-baby visits;

   4. A program that reimburses individuals for the cost of smoking cessation
   programs without regard to whether the individual quits smoking; or

   5. A program that provides a reward to individuals for attending a periodic
   health education seminar.

B. Notwithstanding any provision of § 38.2-3449, 38.2-3540.2, or any other
section of this title to the contrary, a health carrier offering a health
benefit plan providing group health insurance coverage shall not create
conditions for obtaining a premium discount or rebate or other reward for
participation in a wellness program that is based on an individual satisfying a
standard related to a health status factor, except in instances where the
following requirements are satisfied:

   1. 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, does not exceed 30 percent of the
   cost of employee-only coverage. If, in addition to employees or individuals,
   any class of dependents may participate fully in the wellness program, such
   reward shall not exceed 30 percent of the cost of the coverage in which any
   employee or individual and any dependents are enrolled;

   2. The wellness program is reasonably designed to promote health or prevent
   disease;

   3. The health carrier gives individuals eligible for the program the
   opportunity to qualify for the reward under the program at least once each
   year;

   4. The full reward under the wellness program is made available to all
   similarly situated individuals. The reward is not available to all similarly
   situated individuals for a period unless the wellness program allows for a
   reasonable alternative standard or waiver of the otherwise applicable standard
   for obtaining the reward for any individual for whom, for that period, (i) it
   is unreasonably difficult due to a medical condition to satisfy the otherwise
   applicable standard or (ii) it is medically inadvisable to attempt to satisfy
   the otherwise applicable standard. The health carrier may seek verification,
   such as a statement from an individual&#8217;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;
   and

   5. The health carrier discloses, in all health benefit 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 subdivision 4. If plan materials disclose that such a
   program is available without describing its terms, the disclosure under this
   subdivision shall not be required.

HISTORY: 2013, c. 751.