Example 5. (i) Facts. In conjunction with an annual open enrollment period, a group health plan provides a premium differential based on tobacco use, determined using a health risk assessment. The following statement is included in all plan materials describing the tobacco premium differential: “Stop smoking today! We can help! If you are a smoker, we offer a smoking cessation program. If you complete the program, you can avoid this surcharge.” The plan accommodates participants who smoke by facilitating their enrollment in a smoking cessation program that requires participation at a time and place that are not unreasonably burdensome or impractical for participants, and that is otherwise reasonably designed based on all the relevant facts and circumstances. The plan pays the cost of the program. Any participant can avoid the surcharge by participating in the program, regardless of whether the participant stops smoking.After all, results are so... resulty. Can't punish someone for trying! By the way, what do you want to bet that buried somewhere in the regulations there's some kind of statement that says something to the effect of: Coverage may not be cancelled, however, regardless of whether the participant pays the surcharge.
Monday, November 26, 2012
Just Call Me A Resultist
While I cannot say for sure that this mindset is unique to insurance under ObamaCare, I found the following example in proposed regulations from the Department of Health and Human Services to fit the stereotype of what one would expect from the government. This example is part of the explanation for section §54.9802-1 - Prohibiting discrimination against participants and beneficiaries based on a health factor [emphasis added]: