28 Tex. Admin. Code § 21.4705 - General Provisions Applicable to Wellness Programs

(a) Wellness programs as set out in this subchapter are excepted from the general prohibitions against discrimination based on a health status-related factor for plan provisions that vary benefits, including cost-sharing mechanisms, or the premium or contribution for individuals eligible for plan coverage, in connection with participation in such a wellness program.

(b) A wellness program must be reasonably designed to promote disease prevention, wellness, and health. A program satisfies this standard if it:

(1) has a reasonable probability of improving the health of, or preventing disease in, participating individuals;

(2) is not overly burdensome;

(3) is not a subterfuge for otherwise prohibited discrimination based on a health status-related factor; and

(4) is not highly suspect in the method chosen to promote disease prevention, wellness, and health.

(c) A wellness program must comply, as applicable, with Insurance Code § 1701.061 and provisions of rules codified in this title relating to Insurance Code § 1701.061 and the administration of noninsurance benefits.

Notes

28 Tex. Admin. Code § 21.4705

The provisions of this §21.4705 adopted to be effective March 31, 2009, 34 TexReg 2135; Amended by Texas Register, Volume 40, Number 29, July 17, 2015, TexReg 4693, eff. 7/22/2015