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Fitness Formula Clubs is proud to announce the roll out of a new comprehensive health initiative and weight loss study for the medical community, and we are inviting you or someone you know to be one of the first to experience it! FormuLife Rx is a lifestyle subscription to help you create, control and complete your own fitness and nutrition goals. In addition to an FFC membership, qualified candidates of FormuLife Rx will partake in weekly one-on-one nutrition consultations with one of our registered dietitians, and specialty group exercise classes created exclusively for you. The Affordable Care Act will expand the ability of employers to reward workers who achieve health improvement goals.
The poor health habits of many workers, growing rates of chronic disease, and the rising cost of health benefits have created new interest in workplace wellness programs.
The Affordable Care Act of 2010 will, as of 2014, expand employers' ability to reward employees who meet health status goals by participating in wellness programs--and, in effect, to require employees who don't meet these goals to pay more for their employer-sponsored health coverage. This brief explains trends in wellness programs, details changes in the law starting in 2014, and highlights issues to watch. The larger the company, the more likely it was to offer a wellness program; in fact, almost all companies with 1,000 or more employees offered one. INDUCEMENTS TO PARTICIPATE: Although almost all workplace wellness programs are voluntary, employers are increasingly using incentives to encourage employee participation. Employers are also linking participation in wellness programs to employees' costs for health coverage--for example, by reducing premium contributions for workers who are in wellness programs, or by reducing the amounts they must pay in deductibles and copayments when they obtain health services. One 2011 survey of about 600 large US employers found that nearly half already use or plan to implement financial penalties over the next three to five years for employees who don't participate in wellness programs. Although these incentives and disincentives do prompt workers to participate in wellness programs, the evidence is mixed on whether the result is real improvements in health outcomes. A review of 17 studies by researchers at Oxford University found no difference in outcomes among participants in a smoking cessation program between those who received a financial reward and those who did not. On the other hand, a series of studies conducted by researchers at the University of Pennsylvania showed positive results associated with programs using financial rewards. Employer wellness programs must comply with a number of federal and state requirements, such as the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). For example, employers offering a health plan must allow all qualified employees to enroll and may not require larger premium contributions from enrollees who have medical conditions. TWO PROGRAM TYPES: HIPAA regulations, finalized in 2006, categorize wellness programs into two groups.
The second category includes programs that require an individual to meet a health status standard to obtain a reward.
The total of all rewards offered to an individual under the program cannot exceed 20 percent of the total cost (employer and employee portions) of individual employee health benefits coverage (comparable rules apply for family coverage).
The wellness program must be designed to improve health or prevent disease and must not be overly burdensome. Individuals must be given a chance to qualify for the reward or rewards on at least an annual basis. The full reward must be available to all similarly situated individuals, and a reasonable alternative must be provided for those with a medical condition that makes it unreasonably difficult to meet the standard. Whether rewards for participating in a wellness program are viewed by employees as incentives or penalties may depend on how the program is structured.
An example of a wellness program permissible under HIPAA is an employer health plan that asks enrollees to certify that they have not used tobacco during the previous year. The alternative standard requires an individual to participate in a smoking cessation program, but does not require that the individual actually quit smoking. The Affordable Care Act gives these HIPAA regulations the weight of law and also makes one significant change: The limit on the total allowed amount of wellness program rewards is increased from 20 percent of employee health benefit costs to 30 percent, effective in 2014.
In 2010 the secretaries indicated that they intend to use their regulatory authority to raise the limit to 30 percent prior to 2014, accompanied by additional consumer protections to prevent discrimination against employees. There is widespread support for wellness initiatives in the workplace among both employers and employees.
In general, business groups want employers to have maximum flexibility to design programs with rewards or penalties that will encourage employees to not only participate but also to achieve and maintain measurable health status goals, such as quitting tobacco use or reducing body mass index. Unions, consumer advocates, and voluntary organizations such as the American Heart Association are generally wary of wellness initiatives that provide rewards or penalties based on meeting health status goals. They argue that such incentives are unfair because an individual's health status is a result of a complex set of factors, not all of which are completely under the individual's control.
BARRIERS TO WELLNESS: Concerns also have been raised that, by instituting programs designed to alter employees' behavior, employers may be crossing the line with regard to privacy issues.
In addition, some critics warn that wellness program requirements may be used to discourage employees from participating in their employers' health benefits plan by making their participation unaffordable. There are provisions in the Affordable Care Act to discourage such employer behavior; for instance, companies with more than 50 employees are subject to penalties if even one employee obtains subsidized health insurance through an exchange. Several issues related to insurance coverage and employer wellness programs will need to be addressed through regulations. In addition, regulations will need to spell out how wellness-related increases in deductibles or copayments will affect requirements that large employers cover at least 60 percent of the average costs of benefits.

Our new members come to us for all kinds of reasons and with varied starting fitness levels.
Although most people have similar goals to achieve, we take the specifics of your goal very seriously and provide you with Personalised Training to help you get to your goals as soon as possible. Our first step is to get to know you and what you are specifically looking for from your fitness program. After your initial consultation we will start to join you in our Personalised Training programs at a level that is appropriate for you. As you progress through each workout you will soon find that exercises and levels that were challenging are now becoming easier. As an added convenience feature, we allow all of our prospective clients to schedule their appointments online, through our website.
He has post graduate training in Spinal Biomechanics, Evaluation and Treatment of Whiplash Injuries, Cranio-Sacral Adjusting, Holistic Health Care, Nutritional Counseling, and Therapeutic Exercise Training. I notice a huge difference in energy levels between the time when I started my treatment until now. Over the past eighteen months, I have seen a total transformation in both my physical appearance and the way I feel.
The level of stress that I experienced in my life before I began treatment at Whole Body Health was overwhelming.
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The study design is for weight loss and you must have the need to lose weight (defined by a BMI of 30 or more) to participate.
As a participant in this weight loss study, you will be given access to a one-month unlimited membership at one of our participating clubs, which includes state-of-the-art strength and exercise equipment, a knowledgeable and friendly fitness staff, with various amenities, dozens of group exercise classes and more. You will use a technology program to track your success and assist in coaching you through your progress. Employers value these programs as a way to reduce absenteeism and employee turnover, and to offer a benefit that is appealing to many current and prospective employees. Should programs offer "carrots"--financial rewards for participating in wellness programs? Some consumer advocates argue that this ability to differentiate in health coverage costs among employees is unfair and will amount to employers' policing workers' health.
The 2011 Kaiser Family Foundation and Health Research and Educational Trust annual survey of employer health benefits found that 67 percent of companies with three or more employees that offered health benefits also offered at least one wellness program. These incentives range from such items as t-shirts or baseball caps to cash or gifts of significant value.
Another trend among employers who offer multiple health plans is to allow participation in a comprehensive plan only to those employees who agree to participate in the wellness program. More than 80 percent of those who use or plan to use penalties say they will do so through higher premiums. And to date, there have been no published, independent studies on how changes in premiums or cost sharing affect health outcomes. Another group of researchers in the United Kingdom reviewed nine randomized controlled trials of obesity treatment and found no significant effect of the use of financial incentives on weight loss or maintenance of weight loss at 12 and 18 months. One study found that financial incentives were effective in producing weight loss, but the results were not fully sustained seven months after the program ended.
The issues discussed in this brief relate mostly to HIPAA provisions that prohibit employer health benefit plans from discriminating against individuals based on any factor connected with their health status.
HIPAA does allow employers to provide rewards for employee participation in a wellness program.
The first consists of those programs that are available to all similarly situated individuals and do not require a participant to meet any standard related to health status to receive a reward. Rewards may be in the form of premium discounts or rebates, lower cost-sharing requirements, the absence of a surcharge, or extra benefits.
For example, an employer who currently offers health benefits with a $100 per month employee contribution requirement may offer a carrot in the form of a $50 monthly rebate for those who participate in the wellness program.
Enrollees who do not provide the certification are assessed an annual surcharge of $1,000 (20 percent of the $5,000 cost of employee-only coverage under the plan). This program meets the five HIPAA requirements, since nicotine addiction is a medical condition. Therefore, using the above example, beginning in 2014, the maximum surcharge on enrollees who do not participate in the wellness program could be as high as $1,500.
At the same time, there is conflict over programs that tie rewards or penalties to individuals achieving standards related to health status--and especially over those arrangements that affect employee health insurance premiums or cost-sharing amounts.
They argue that individuals should bear responsibility for their health behavior and lifestyle choices and that it is unfair to penalize an employer's entire workforce with the medical costs associated with preventable health conditions as well as the costs of reduced productivity.
They are concerned that, rather than improving health, such approaches may simply shift heath care costs from the healthy to the sick, undermining health insurance reforms that prohibit consideration of health status factors in determining insurance premium rates.

For example, genetic predisposition plays a significant role in determining many health status factors, including such attributes as excess weight, blood pressure, blood sugar, and cholesterol levels. Another concern is that tying the cost of insurance to the ability to meet certain health status goals could discriminate against low-income individuals or racial and ethnic minorities. Barriers outside of work may include personal issues, such as financial burdens, and environmental factors, such as unsafe neighborhoods, poor public transportation, and lack of access to healthy food. For example, under the Affordable Care Act, employees who have access to employer-provided coverage may not purchase coverage through exchanges, and receive federal subsidies to offset some of the costs, unless the premiums they pay toward their employer-sponsored coverage exceed 9.5 percent of family income. Health Affairs is pleased to offer Free Access for low-income countries, and is a signatory to the DC Principles for Free Access to Science. Your Personalised Trainer will take you through an introductory fitness session which will include an assessment of your baseline fitness and we will take you through an initial workout to show you how to use the fitness equipment. If you are someone that has not been to a gym for a while, the sessions will be low-moderate intensity initially whilst we build up your fitness. Whereas in the past you may have experienced a plateau in your results, your Personalised Trainer will continually adjust your workouts so that you are getting consistent progression! David Williams is a 1991 Magna Cum Laude graduate of Palmer College of Chiropractic in Davenport, Iowa.  He has a Bachelor of Science Degree in Anatomy, and Doctor of Chiropractic Degree. I have genuinely experienced relief from my ailments and look forward to further treatments. No reproduction, transmission or display is permitted without the written permissions of Rodale Inc. Throughout your first month, you can expect to lose weight, learn healthy eating habits and begin to incorporate beneficial changes into your daily routine. Some evidence also suggests that comprehensive wellness programs may pay off for employers by reducing their expenditures for employees' health care. Slightly more than half (52 percent) also offered wellness benefits to spouses or dependents of employees. For small companies, wellness programs are typically run by the same firms that administer the employer's health benefits plan or by another entity referred to as a third-party administrator. Similarly, a 2005 meta-analysis of 56 published studies of health promotion programs at organizations of all sizes resulted in an overall reduction of about 25 percent in sick leave, health plan costs, and workers compensation and disability costs. Studies indicate, moreover, that financial incentives do prompt more employees to participate in wellness programs. Those employees who do not participate in a wellness program are offered a less comprehensive plan, or one that requires them to pay more in premiums or cost sharing. In another study, financial rewards significantly increased rates of smoking cessation among 878 employees of a large U.S. Wellness programs that are separate from the employer health plan may be subject to other state and federal nondiscrimination laws, such as the Americans with Disabilities Act, but are not subject to the HIPAA nondiscrimination rules. On the other hand, if that same employer instead increased the employee contribution to $200 per month and offered a rebate of $100 per month for meeting wellness program requirements, the change might be more likely to be perceived as a stick, or penalty. Materials describing the terms of the wellness program must state that a reasonable alternative standard will be available to those for whom it is unreasonably difficult, or medically inadvisable, to meet the requirement. Because $1,000 is the maximum amount allowed in this case, this wellness program may not impose any other rewards or penalties related to health status factors. The law also gives the secretaries of the departments of Health and Human Services, Treasury, and Labor the discretion to raise this amount to a level as high as 50 percent of employee health benefit costs. Consumer advocates also caution that poorly designed and implemented wellness initiatives may have unintended consequences, such as coercing an individual with a health condition to participate in an activity without adequate medical supervision. These individuals are more likely to have the health conditions that wellness programs target and also may face more difficult barriers to healthy living. Regulations will be needed to clarify how wellness program rewards or surcharge amounts will be counted in computing the total amount of premiums that employees are paying to calculate whether their total premiums do exceed this income threshold. If you are someone that has an established fitness base, we will quickly adapt your program to take your fitness to the next level; That’s what EFM Fitness Coaching is all about!
At the end of six weeks you'll be able to do a full hour on the road—and you'll score a killer body that's 10 pounds lighter. Should either carrots or sticks be tied to an individual's success in meeting health goals, such as managing blood pressure or losing weight? Examples include gym memberships or tobacco cessation programs offered by an employer without regard to whether participants actually lose weight or quit tobacco use. Ethical Guidelines for Holding Employees Responsible for Their Health," Health Affairs 28, no.
The group receiving the financial incentives also had a higher participation rate in the smoking cessation program.

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