Want insurance? Get on the scale

This post comes from Jen Wieczner at partner site MarketWatch.

The Affordable Care Act requires employers to offer health insurance, but some companies are making workers jump through new hoops to get it.

In order to be eligible for some -- or all -- of the company health plan, 15% of employers now require employees to undergo biometric screening or fill out a health assessment, according to a survey by Fidelity Investments and the National Business Group on Health.

In the case of screenings, employees typically have to step on a scale, have their waistline measured, and get blood drawn to test cholesterol and glucose levels.

"There are some companies saying, 'Gee, we're spending an awful lot on health care. We would like you to do certain things,'" says Adam Stavisky, a Fidelity benefits consultant.

While most of those companies required such measurements only for access to their richer, top-tier health plans -- which commonly offer higher employer reimbursement or a wider doctor network -- 3% of employers said they would cut benefits for workers who didn't complete the screenings.

Benefits experts say it's no more unreasonable to make employees get their vital measurements taken than to fill out paperwork during health plan enrollment. Even the required blood work is usually part of a routine checkup, they say, and people can only get healthier if they know where they stack up on crucial measures.

"It's something that everybody needs to have for their own sake," says Helen Darling, president and CEO of the NBGH. "The people who might claim that they are discriminated against would be the very people you'd want to have a primary care physician, and talking to doctors and nurses."

Biometric screenings may not be the gatekeeper for most health plans, but they are increasingly becoming a pillar of modern corporate wellness programs. More than 40% of employers currently -- or are planning to -- tie biometric measurements to premiums or health plan incentives, according to the survey. About a third of companies reward employees for lowering cholesterol or blood pressure, while 11% pay employees who get skinnier.

Critics, however, worry that the practice of using so-called "outcomes-based incentives" amounts to insurance underwriting and could decrease access to health care -- something the Affordable Care Act is trying to prevent.

"There's real concern that if people perceive some of the new incentives rules as penalizing people for their health behaviors, then that could actually distance people from accessing health care," says Paul Terry, CEO of StayWell Health Management, a company that offers wellness services to employers, including biometric screenings.

Asking employees to pay up to 30% more in premiums -- the wellness incentive maximum beginning 2014, according to proposed Affordable Care Act guidelines -- for being "morbidly obese" is "just really unrealistic," Terry adds. (He has recently stopped using the term "outcomes-based" for employer wellness incentives in favor of "health-contingent programs" to avoid this connotation.)

Employers who charge different health premiums based on biometric test results must legally allow people who fail to hit the targets to pay the same amount if they provide a doctor's note or enroll in a program to achieve their goal, like Weight Watchers. That means employees can get the same rewards just for participating in a health-promoting program, whether or not they actually lose weight or get healthier.

StayWell, on the other hand, recommends that companies find a middle ground by rewarding people for taking the biometric test and then achieving personalized, realistic goals based on the measurements. "Rather than simply saying 'hit the outcome or else,'" Terry says, "why wouldn't we say to employees, 'show us some progress that you're moving in the right direction in order to achieve the reward?'"

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