Prevention Group: From Clinics to Worksite Wellness

Wellness Incentives

Appeals

Legal StampA clear component of the health care law applicable to Results-based incentives deals with the process of appeals. Any communication regarding rewards or loss thereof must declare the existence of a meaningful appeal process:

  • Employees can appeal the accuracy of a biometric parameter. One cure for this appeal is retesting per a health care provider, usually at the employee’s expense, with submission of a physician record outlining the retested value
  • Employees can appeal for an alternative standard. For example, if the employee is obese and unable to achieve a healthy standard in the time frame allowed, the employee can choose to accept a progress-based incentive with a goal of a 10 pound weight loss in 12 months or appeal to have an individualized goal set by a healthcare advisor
  • The employee can appeal for total exemption based on medical circumstance. An individual who is pregnant oro under medical care for a life-threatening condition, for instance is eligible for an automatic waiver
  • Just as the screening process must be repeated at least annually, the appeals process must also be handled in a timely and professional manner

The Prevention Group Scoreboard data management system streamlines the process of appeals.