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Get Informed about the Final Wellness Regulations

Story Content Provided by Aetna on 7/16/13

 On May 29, 2013, the U.S. Departments of the Treasury, Labor (DOL) and Health and Human Services (HHS) issued final regulations modifying the 2006 HIPAA nondiscrimination wellness regulations from November 2012 to implement the employer wellness program provisions of the Affordable Care Act (also known as the PPACA or health care reform).

These rules are effective for plan years beginning on or after January 1, 2014.

The final rules apply to both grandfathered and non-grandfathered group health plans and both insured and self-funded plans. These regulations do not apply to the individual market in all states. The final regulations do not differ much from the November 2012 proposed regulations, but there are a few key differences from the 2006 HIPAA regulations.

Bottom Line: The HIPAA nondiscrimination rules prohibited a group health plan from discriminating against an individual based on a health factor, except in two circumstances: (1) if the discrimination is in favor of an individual with an adverse health status (called "benign" discrimination) or (2) if the discrimination is part of a wellness program that meets the requirements of the HIPAA wellness rules. ACA extended this prohibition against discrimination based on health status to individual health insurance policies but did not also extend the exception for wellness programs. The final regulation allows individual health insurance plans to use participatory wellness programs but not health contingent wellness programs.

Talk to your customers
At the top of this message, you will find links to materials that you may send to your customers. The materials will help guide your discussions regarding compliance with the final regulations.

Talk to Aetna
Aetna will continue to watch for future developments on health care reform.

Talk to your Aetna representative if you have questions. We have a long history of working to build a better health care system. We will continue to work with you to find solutions. For more information on health care reform,
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