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Stack of dollars with bow on top The individual market health-contingent wellness programs cannot base rewards, such as lower premiums and deductibles or cash payouts, on meeting a specific health factor standard. (Photo: Shutterstock)

The Trump Administration is resuscitating a 2013 demonstration project contained within the Patient Protection and Affordable Care Act that would create a 10-state health-contingent wellness test program for the individual health insurance market.

Health-contingent wellness programs have long been controversial because consumer advocates say they tend to favor the already healthy and place additional financial burdens on those in less that peak health. They have been effectively banned from the individual marketplace—save for the demonstration project that was authorized as part of a Final Rule released in 2013. Health-contingent programs differ from participatory programs in that the latter do not set standards of achievement, but merely encourage participation.

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Dan Cook

Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.

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