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March 14, 2013

Lower Insurance prices based on achieving or maintaining cholesterol levels, BMI, blood pressure and other targets

One of my 156 predictions made in 2006 was that Insurance would have pricing based on maintaining biomarkers in optimal ranges in the 2008 and 2012.

An article in 2012, many [worker wellness programs] offer discounted premiums to workers who meet standards related to blood pressure, cholesterol and weight, with the value of those discounts running between $30 and $60 a month, says Jim Pshock, founder and CEO of Bravo Wellness in Avon, Ohio. Pshock administers such wellness programs for about 220 employers nationwide, including Colorado construction firm Oakwood Homes and Nashville’s Ardent Health Services.

Although employers may set specific goals — such as a body mass index (BMI) below the 30, the level considered obese — many also reward achievement of less daunting targets. One employer rewarded workers if their test results didn’t get any worse, Pshock says.

At Swiss Village, workers get $500 off their deductible for each of these measures: not smoking, having a BMI of 27.5 or less, a low-density lipoprotein cholesterol level (LDL) of 130 milligrams per deciliter or less, and blood pressure of 130/85 or less. LDL levels above 129 are associated with higher risk of heart disease, while blood pressure greater than 120/80 is considered a risk factor for heart attack and stroke.



Starting in 2014, federal law allows employers to raise the value of the perk or penalty from 20 percent of the cost of a worker’s health insurance plan, to 30 percent. Based on the average cost of employer-offered insurance today, that means firms will be able to offer annual discounts or penalties of more than $4,500 a family, or $1,600 for individuals.

Employers will still have to craft plans to comply with federal and, in some cases, state requirements, Volpp says. The programs must be voluntary — meaning an employer can’t require a worker to participate as a condition of coverage. And the employer must offer a "reasonable alternative" to qualify for the reward, or to avoid the penalty for those who can’t achieve the sought-after medical goals.

Of the employers who offer such programs, about one-third offer financial incentives to those who undergo specific medical tests, according to the Aon Hewitt survey. And 5 percent of those tie the financial rewards or penalties to meeting specific medical-based standards.

The survey also found the use of medical screening tests poised to expand to family members: 57 percent of employers said they planned to add incentives for spouses and dependents in the next three to five years.

Faced with crippling healthcare costs, the number of employers embracing such programs shot up from 49 percent in 2010 to 54 percent last year — and more say they expect to do so soon, according to a survey by consultants Aon Hewitt. Big-name participants include insurer UnitedHealthcare, car rental firm Hertz, postage meter maker Pitney Bowes and media owner Gannett, owner of USA TODAY.

And more employers are expected to adopt them starting in 2014, when the health law allows them to offer larger incentives or penalties than they can now.

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