Everyone knows that maintaining good health is important as we age. It helps to prevent not only aches, pains, and low energy, but it also staves off the onset of a variety of ailments, chronic illnesses, and diseases. Maintaining good health can also help to keep medical costs low, which is why many employers and health insurance providers support preventive care.
Where do gym memberships fit into this equation? Both insurance providers and employers have the option to offer wellness programs as part of insurance policies. These programs could include options for preventive health screenings, substance abuse programs (to quit smoking, drinking, or drug use, for example), and options for weight loss, management of conditions like diabetes, and other activities designed to improve health.
In some cases, wellness programs include coverage (or at least partial coverage) for the cost of gym memberships. Here are a few options you may want to discuss with your employer and/or your health insurance provider.
Participatory Programs
There are a couple of different types of wellness programs allowed under ACA (Affordable Care Act, or Obamacare) regulations. The first type of program is participatory, which means employees or plan members that participate are not granted rewards or they are not required to meet health standards (say for cholesterol levels or blood pressure, just for example).
In practice, this could mean that employees gain rewards simply for participating in educational health seminars or submitting to health risk assessment (regardless of results), or that these opportunities are offered free of charge (with no other reward). Such programs could also encourage healthier living by reimbursing employees that participate in drug rehabilitation or smoking cessation programs, or that pay out-of-pocket for gym memberships.
In such programs, participation is all that is required to gain benefits – they need not necessarily prove progress by measurable standards in order to receive reimbursement or rewards.
Health-Contingent Programs
The second type of wellness program is a health-contingent program, by which those who participate must meet set standards in order to qualify for reimbursement or rewards from an employer or health insurance provider. Under this heading, there are generally two ways to meet standards: through activity-based participation or outcome-based participation.
In other words, participants must either complete certain activities or achieve certain outcomes. For example, an activity-based program may require participants to follow a certain diet or exercise a set amount of time, say 30 minute sessions three times a week, in order to gain reimbursement for a gym membership. Outcome-based participants may have to achieve set goals like lowering their BMI to a specific number or giving up smoking.
There are many rules and regulations pertaining to health-contingent wellness programs to avoid discrimination, reduce undue burden on participants, and generally meet the goals of preventing disease and/or promoting health. It’s a good idea to understand all rules prior to participating in such wellness programs to ensure that you are able to gain reimbursement for your gym membership.
Reasonable Alternative Standard
Not everyone will have the opportunity to participate in wellness programs (especially those that are health-contingent) and gain the rewards or reimbursement they entail. Those who are medically unable to participate under set standards must be allowed to substitute a reasonable alternative activity or outcome in order to gain rewards.
If your employer or insurance provider offers a wellness program but you are unable to participate due to medical or other hardship, ask for a reasonable alternative to be provided. By law, any health-contingent wellness program must comply.
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