Macy's Lawsuit: SelfHelpWorks Offers Clarity For Wellness Programs

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In August 2017, Macy’s and their third-party administrators were sued by the US Department of Labor, which alleged that Macy’s failed to properly apply the Affordable Care Act’s Reasonable Alternative Standard rules for incentivized wellness programs (see Winston & Strawn LLC article regarding Acosta v. Macy’s, Inc. et al., S.D. Ohio, No. 1:17-cv-00541, complaint filed 8/16/17, amended complaint filed 8/29/17). SelfHelpWorks explains the issue and how to offer a legally compliant Reasonable Alternative.

Lou Ryan, SelfHelpWorks Founder & CEO

Lou Ryan, SelfHelpWorks Founder & CEO

If your company offers an incentivized health plan or wellness program, it's wise to seek the correct legal advice to make sure you're in compliance.

Employers with wellness programs usually incentivize employees in a bid to improve participation and outcomes. However, as evidenced in a recent lawsuit filed by the Department of Labor against Macy’s and its third-part administrators (see Winston & Strawn LLC article regarding Acosta v. Macy’s, Inc. et al., S.D. Ohio, No. 1:17-cv-00541, complaint filed 8/16/17, amended complaint filed 8/29/17), many employers are still not clear on some of the nondiscrimination rules that apply to wellness program incentives and health plan surcharges. SelfHelpWorks explains the issue and how to offer a legally compliant Reasonable Alternative.

In August 2017, Macy’s and their third-party administrators (TPAs) were sued by the US Department of Labor. Among the allegations: they failed to properly apply the Affordable Care Act’s Reasonable Alternative Standard rules allowing their smokers to avoid a health insurance surcharge.

Bryan Noar, General Manager of SelfHelpWorks - a company whose online video courses are often used by wellness program managers as a Reasonable Alternative - pointed out that employers who offer health and wellness incentives to their employees would be wise to take heed.

“The important thing to note here is that Macy’s did in fact offer their smokers a tobacco cessation program that would allow them to qualify for the tobacco-free health insurance rates,” said Noar. “However, the Reasonable Alternative requirements are complex and the way the smoking cessation program was offered allegedly fell short.”

Cutting through the complexities of the lawsuit, there appear to be three main alleged problems with the way the smoking cessation program was offered as a Reasonable Alternative:

1) The availability of the Reasonable Alternative Standard was not properly disclosed.

2) The smoking cessation program was unreasonably difficult for some individuals to complete for medical reasons, meaning that these people were not in fact offered a “reasonable” alternative given their particular circumstances.

3) The plan continued charging the tobacco surcharge to individuals who didn’t remain tobacco-free for at least 6 consecutive months during the year – even though they had completed the tobacco cessation program. This is definitely an issue if true.The whole purpose of the Reasonable Alternative is to allow certain employees to earn incentives or avoid surcharges, even if they cannot achieve a particular health standard.

Said Noar, “The lesson you can take away from the Macy’s lawsuit is that if your company offers an incentivized health plan or wellness program, it’s wise to seek the correct advice to make sure you’re in compliance. The rules regarding the Reasonable Alternative Standard can be complex and it’s just not worth the risk of running into regulatory issues down the road.”

Although they are not legal experts, SelfHelpWorks knows more about the ins and outs of these rules than most, because their targeted online interventions are often used by employers and their advisers as a Reasonable Alternative – particularly in the areas of tobacco, weight loss and blood sugar levels. The company’s founder, Lou Ryan, explained why.

“Reasonable alternatives come in various forms, some more likely to produce positive outcomes than others,” said Ryan. “Our video-based online courses are a popular Reasonable Alternative for two reasons: first, they are suitable for virtually any employee regardless of health status. And second, the success rates are extremely high.”

Simply put, when a participant begins a SelfHelpWorks program, chances are very good they will soon be making a positive and long-lasting lifestyle change. To learn more about the science behind the SelfHelpWorks programs and the high efficacy rates, the company website is a good place to start.

ABOUT SELFHELPWORKS, INC.
SelfHelpWorks is the leading provider of online video-based lifestyle and disease management interventions for reducing population health risk. The interventions produce sustained behavior change using an evidence-based cognitive behavioral training approach derived from cognitive behavioral therapy (CBT). They target important issues such as obesity and unhealthy eating, tobacco addiction, diabetes, chronic stress, alcohol abuse and inactivity. The interventions are primarily offered by corporations interested in improving employee health and productivity, and by top tier value-based health and wellness providers. Users can access them privately and conveniently 24/7 via computer, tablet or smartphone.

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Bryan Noar
SelfHelpWorks
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