What is the Origin of Health-Contingent Outcomes?

The concept is a regulatory term derived from the Health Insurance Portability and Accountability Act (HIPAA) and its subsequent amendments concerning wellness programs. It differentiates between participatory wellness programs, which reward activity, and health-contingent programs, which reward a specific physiological result. This distinction is crucial for legal compliance and non-discrimination rules.

What is the Mechanism of Health-Contingent Outcomes?

The mechanism functions by setting a physiological benchmark, which the employee attempts to meet through lifestyle modification or clinical management. To ensure fairness, especially for those with chronic hormonal or metabolic disorders, the program must offer a "reasonable alternative standard" that allows the individual to still earn the reward without meeting the primary health metric. This regulatory requirement ensures the program remains an encouraging health initiative rather than a discriminatory barrier.

Health-Contingent Outcomes ∞ Area

Health-Contingent Outcomes

Meaning

This term describes the specific, measurable physiological results that an individual must achieve or maintain in order to qualify for a financial reward or avoidance of a penalty within a workplace wellness program. Examples include attaining a target body mass index (BMI), reducing blood pressure to a specific level, or maintaining certain lipid or glucose parameters. These outcomes are distinct from simply participating in an activity and must be assessed with reasonable alternatives for individuals with medical conditions.