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Feb 2015

The Fine Print in Wellness Programs

Americans who suffer from chronic health conditions are costing businesses and health insurance companies billions. According to the Center for Disease Control (CDC), diagnosable obesity, heart disease and high blood pressure are on the rise at an alarming rate. The National Coalition on Health Care noted that the amount Americans spend on health care is four times as much as the government spends on national defense! And according to The Wellness Council of America, 80 percent of all health insurance costs are a result of those with chronic conditions.

Businesses, especially those with self-funded health plans, along with health insurance companies, have a big financial incentive to keep their employees or their insureds healthy and to reduce health care costs. Is it any wonder that wellness programs are being offered by over 80 percent of American businesses with more than 50 employees, and by just about every health insurance company?

Wellness Programs: A Win-Win For Everyone

Wellness programs are opportunities and incentives provided by your employer or health insurance company to participate in programs and activities that encourage a healthy lifestyle. These programs are designed to address both physical and emotional issues, and may include smoking cessation, weight loss, stress management (such as yoga or alternative medicine), gym memberships or discounts, personalized nutritional education, or family/personal therapy. Sometimes, bonus goodies such as iPods, televisions or even additional vacation days are offered to employees as an incentive to participate.

Creating a healthy lifestyle, making good choices, reducing stress and getting into better physical and emotional shape is a win-win for everyone. You will likely feel better, experience less stress and reduce your risk for serious health setbacks. For your employer, a healthier employee with less stress means less absenteeism and a more productive employee, in addition to potentially lower health insurance premiums. For the insurance company, healthier insureds mean fewer payouts on claims from doctors and hospitals, and this leads to healthier profits.

The Dark Side of Wellness Programs They Don’t Tell You

In spite of all those benefits, keep in mind there is a dark side to wellness programs that insurance companies may not want you to know about. The information that you or your employer voluntarily provide can be used by the insurance company in many ways, one of which is for rating purposes — that is, to determine whether your insurance premiums should be increased come renewal time.

Health Data You Are Knowingly or Unknowingly Sharing

One of the basic tools insurance companies use in administering their wellness programs is to have the insured take a health risk assessment, fill out a health questionnaire and/or take a detailed survey. These are tools used to establish a baseline so that the participant can track how healthy he/she is getting, or so that the company can best advise the participant as to what programs might be of most benefit.

However, these assessments and questionnaires are also a wealth of data, which is mined by the insurance company to get a much clearer picture of who is healthy (lower risk) and who is not (higher risk). Using this data, forecasts can be compiled regarding future health care costs and decisions about future premium increases.

Another tool that is becoming popular is the use of mobile apps on your smartphone, which allow you to track your health expenses, fitness goals, progress and more. One such app designed by a health insurance company (to remain nameless), and offered free of charge, allows you to track your blood pressure numbers, blood sugar, body mass index, cholesterol and waist circumference. It allows you to track medical appointments and will even send you reminders. The app encourages you to keep track of the medical advice given to you by your doctor after the appointment. All of this information is great for the app user, but guess who also has access to all of this information? The insurance company. By using the app, you are voluntarily feeding personal medical information directly to the insurance company and allowing them to use it for their purposes.

Read the Fine Print

Skeptical? Let’s look at the fine print. When you download the app mentioned above, you are asked to review and agree to, among other things, a “Privacy Policy.” You cannot download the app unless you agree. Part of what you are agreeing to is to allow the insurance company to access the information that you put into the app. This includes your “age, address, phone number, or health information,” the reminders they send out, and the calendar that you fill in. You are also agreeing to allow the insurance company to perform analytics “to improve [their] products, mobile applications and advertising,” and for them to “develop reports regarding usage, development, and research.” And of great interest is that you will be giving permission for them to use your health information “[a]s otherwise necessary or useful for [them] to conduct [their] business, so long as such use is permitted by law and this policy.” This is a rather broad and subjective category of permissive use!

But is it Legal?

Currently, there is no law forbidding the insurance company from using the data it collects from the wellness program surveys, questionnaires, assessments or apps to forecast health care costs and potentially increase your premiums. The good news is that you are not required to complete the survey, questionnaire or assessment in order to participate in the wellness programs, nor is it necessary to provide all of the requested information in the app. It is not mandatory, just strongly encouraged by the insurance company.

What Can You Do?

One smart choice is to do whatever it takes to get healthy, and wellness programs do have a lot to offer in this regard. Additionally, another smart choice is to be informed. Read the fine print. Most people do not take the time. Remember, the fine print is “fine” for a reason – to make it more difficult to read and thereby to discourage the reader actually reading it. It’s not like they are going to run out of room on a website! This should be a red flag.

Be healthy and be informed..

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