SB1264.DOC

SECTION 1. The legislature finds that as healthcare insurers, employers, and medicaid programs expand the reach and approach of wellness programs for participants as a means to control costs and promote health, there has been a significant increase in incentive-based wellness programs employing mandatory requirements and conditions on participants with punitive results, and it has become apparent that protections are needed.

The federal Patient Protection and Affordable Care Act and the Hawaii Prepaid Health Care Act sought to encourage and extend healthcare coverage to individuals who may have difficulty otherwise obtaining coverage, but mandatory wellness programs and programs with punitive consequences may discourage such increased participation, especially among vulnerable populations. Voluntary wellness programs that encourage and motivate healthy behavior have been most successful and are consistent with the goals of the Patient Protection and Affordable Care Act and the Hawaii Prepaid Health Care Act to encourage and extend healthcare coverage. Research has not shown that mandatory wellness programs requiring participation are any more successful, though they can lead to serious negative consequences for participants. As stated in the recently-issued Joint Consensus Statement of the Joint Committee of the Health Enhancement Research Organization, American College of Occupational and Environmental Medicine, American Cancer Society and American Cancer Society Cancer Action Network, American Diabetes Association, and American Heart Association, "The fundamental goal of any wellness program should be to provide opportunities for individuals to improve their health and wellness. A wellness program should not be used in a way that threatens an employee's ability to maintain health insurance because any resulting decrease in access to care would be in direct conflict with the primary objective of improving employee health."

The purpose of this Act is to establish protections for participants of health benefit plans by adding a new part to the patients' bill of rights.

SECTION 2. Chapter 432E, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part . Wellness Programs

§432E- Definitions. As used in this part:

"Healthcare insurers" means health carriers, including companies or organizations that provide or sell a health benefit plan and the Hawaii employer-union health benefits trust fund.

"Participants" means consumers of health benefit plans and their dependents, employees receiving healthcare coverage or insurance through an employer and their dependents, and medicaid beneficiaries.

"Wellness program" means a program designed to promote health and prevent disease that may contain rewards and incentives for participation and includes programs offered by healthcare insurers, employers, and medicaid programs.

§432E- Ability to offer participatory wellness programs. Healthcare insurers, employers, and medicaid programs may offer participatory wellness programs to their respective participants subject to the restrictions of this part.

§432E- Participation in wellness program. (a) Participation in a wellness program shall be voluntary on the part of the participant and shall be available to all similarly-situated participants of the insurer, employer, or medicaid program plan. When offered by an insurer, the terms of the wellness program shall be set forth in the plan's 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 management program;

(5) A worker injury prevention program;

(6) A nutrition education or healthy food program; and

(7) Health or fitness incentive programs.

(c) A wellness program may use rewards and incentives for participation that do not contradict voluntary participation, as follows:

(1) Permissible rewards and incentives shall include:

(A) Full or partial reimbursement of the cost of participating in smoking cessation or weight management programs;

(B) Full or partial reimbursement of the cost of membership in a health club or fitness center or goal-orientated fitness training program; and

(C) 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 or foods, over the counter vitamins, exercise equipment, or payment of entry or training fees for exercise classes, athletic events, and competitions; and

(2) Non-permissible rewards and incentives shall include:

(A) A discount in the participant's health benefit plan cost or premium rate;

(B) A rebate or refund of premium to participants;

(D) Adverse employment actions;

(E) Bonuses based on percentage or number of plan participants voluntarily participating in a wellness program; and

(F) Adjustments to employee compensation, rate of pay, or salary adjustment based on individual participation in a wellness program.

§432E- Confidentiality of information due to participation in a wellness program. (a) Any personal health information, including biometrics or health histories, obtained due to participation in a wellness program shall be protected health information for the purposes of this chapter, and shall be protected in compliance with the Health Insurance Portability and Accountability Act of 1996. A participant in any wellness program that utilizes a health risk assessment or other personal health information shall have the option of choosing a health care professional for obtaining and assessing personal health information.

(b) Personal health information shall not be shared with a participant's employer or prospective employer. Any other information obtained due to participation in a wellness program shall not be shared with a participant's employer or prospective employer except to verify eligibility for rewards or incentives offered by the participant's employer.

(c) Any personal health information obtained due to participation in a wellness program shall not be shared with a participant's health insurance provider, except as voluntarily authorized by written permission and direction of the participant."

SECTION 3. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	1264
TWENTY-SEVENTH LEGISLATURE, 2013
STATE OF HAWAII