124 STAT. 158 PUBLIC LAW 111–148—MAR. 23, 2010 addition to employees or individuals, any class of depend- ents (such as spouses or spouses and dependent children) may participate fully in the wellness program, such reward shall not exceed 30 percent of the cost of the coverage in which an employee or individual and any dependents are enrolled. For purposes of this paragraph, the cost of coverage shall be determined based on the total amount of employer and employee contributions for the benefit package under which the employee is (or the employee and any dependents are) receiving coverage. A reward may be in the form of a discount or rebate of a premium or contribution, a waiver of all or part of a cost-sharing mecha- nism (such as deductibles, copayments, or coinsurance), the absence of a surcharge, or the value of a benefit that would otherwise not be provided under the plan. The Secre- taries of Labor, Health and Human Services, and the Treasury may increase the reward available under this subparagraph to up to 50 percent of the cost of coverage if the Secretaries determine that such an increase is appro- priate. ‘‘(B) The wellness program shall be reasonably designed to promote health or prevent disease. A program complies with the preceding sentence if the program has a reasonable chance of improving the health of, or pre- venting disease in, participating individuals and it is not overly burdensome, is not a subterfuge for discriminating based on a health status factor, and is not highly suspect in the method chosen to promote health or prevent disease. ‘‘(C) The plan shall give individuals eligible for the program the opportunity to qualify for the reward under the program at least once each year. ‘‘(D) The full reward under the wellness program shall be made available to all similarly situated individuals. For such purpose, among other things: ‘‘(i) The reward is not available to all similarly situated individuals for a period unless the wellness program allows— ‘‘(I) for a reasonable alternative standard (or waiver of the otherwise applicable standard) for obtaining the reward for any individual for whom, for that period, it is unreasonably difficult due to a medical condition to satisfy the otherwise applicable standard; and ‘‘(II) for a reasonable alternative standard (or waiver of the otherwise applicable standard) for obtaining the reward for any individual for whom, for that period, it is medically inadvisable to attempt to satisfy the otherwise applicable standard. ‘‘(ii) If reasonable under the circumstances, the plan or issuer may seek verification, such as a state- ment from an individual’s physician, that a health status factor makes it unreasonably difficult or medi- cally inadvisable for the individual to satisfy or attempt to satisfy the otherwise applicable standard.
