1. Page 1 Recording of this session via any media type is strictly prohibited. Workplace Wellness Programs: Managing Risk – Health, Financial and Legal

2. Page 2 Recording of this session via any media type is strictly prohibited. Eleanor D. Thompson Special Counsel McCarter & English, LLP Eleanor Thompson has in-depth knowledge of health care reform, particularly The Patient Protection and Affordable Care Act, with its accompanying regulations and agency guidance, and with special emphasis on its impact on large employers. She has over 16 years of in-house experience in the business of health insurance, including managing litigation, risk management and crisis management.

3. Page 3 Recording of this session via any media type is strictly prohibited. What to Expect Learning Objectives 1.Analyze the core components of a well-designed Workplace Wellness Program 2.Analyze the costs, benefits and ROI of implementing a Workplace Wellness Program 3.Recognize the legal risks associated with the design and implementation of Workplace Wellness Programs, including ways to eliminate, reduce or insure against these risks 4.Recommend 10 best practices to ensure an effective and compliant Workplace Wellness Program

4. Page 4 Recording of this session via any media type is strictly prohibited. Carol Staubach, MPH Health Risk Management Consultant CA Staubach & Associates Carol Staubach works with employers to develop effective health management programs and services to promote employee health, productivity, and reduce the use of benefits for avoidable and preventable accidents, illnesses, and disability. Carol has a deep understanding of employment and healthcare laws, with program design and implementation that ensures compliance with all legal requirements to protect the worker.

5. Page 5 Recording of this session via any media type is strictly prohibited. Cost of Care – U.S. Highest of all Nations OECD: The Organisation for Economic Co-operation and Development Health expenditure per person: $8,508 17.7% of GDP: highest of all nations U.S. covers less than 50% of all medical expenses through public funding (same as Mexico and Chile), yet public expenditures on health are second in world: more than $4,000 per person We lead all nations in obesity Life expectancy: 78.7 years – lower than 25 of OECD nations

6. Page 6 Recording of this session via any media type is strictly prohibited. $1.2 Trillion avoidable health care costs $210 billion in defensive medicine $200 billion in preventable conditions Drivers - Behavior 60% of costs related to poor adherence to chronic condition treatment o 25% of all hospital and nursing home admissions o Poor medication adherence Demand for treatment that has no impact on health – e.g. antibiotics Poor lifestyles PriceWaterhouseCoopers Health Research Institute: Identifying Waste in Health Care Spending - 2007 Why Wellness & Prevention

7. Page 7 Recording of this session via any media type is strictly prohibited.

8. Page 8 Recording of this session via any media type is strictly prohibited. Insurance Employers focused on compliance and plan choices and evaluating private exchanges Brokers focused on creating private exchanges Insurers participating in private exchanges Providers concerned reduced reimbursements with more patients All are looking at providing Prevention & Wellness services ACA Impact for 2014

9. Page 9 Recording of this session via any media type is strictly prohibited. Heart Disease................$403 Billion Smoking………………………$157 Billion Diabetes………………………$132 Billion Obesity………………………..$100 Billion High Blood Pressure…….$100 Billion Costliest Controllable Health Issues Courtesy of American Diabetes Assoc., American Heart Assoc., CDC

10. Page 10 Recording of this session via any media type is strictly prohibited. And Even with All We Know….. 2/3 of adults are overweight or obese 67%

11. Page 11 Recording of this session via any media type is strictly prohibited. Some Good News CDC Morbidity & Mortality Weekly 2008–2011 data showed modest reductions in the obesity rate of low-income preschoolers in 18 states and the Virgin Islands “…first time in a generation we're seeing [obesity trends] go in the right direction in 2- to 4-year-olds,“ Thomas Frieden, MD, MPH, director, CDC Environmental Changes – School Nutrition; Physical Activity; Awareness

12. Page 12 Recording of this session via any media type is strictly prohibited. Improve our population’s health Improve our population’s ability to take care of themselves Reduce the incidents of illness and disease Reduce the costs of illness and disease when they occur So We Have a Big Challenge

13. Page 13 Recording of this session via any media type is strictly prohibited. Correlation between health, engagement & productivity Risk of disease: increased by both exposure to occupational hazards and risk-related behaviors Workers at highest risk for exposure are also most likely to engage in risk-related health behaviors Integrate wellness and injury management to increase participation, be more effective and achieve ROI The Connection between Work & Health

14. Page 14 Recording of this session via any media type is strictly prohibited. Health & Productivity Model PROGRAMS Health Risk Assessments Health Screenings Risk Reduction Interventions Education & Awareness PERFORMANCE METRICS Medical/RX Claims Analysis Disability & Workers Comp. Lost Time & Absence Improved Output Health Improvement Outcomes and ROI

15. Page 15 Recording of this session via any media type is strictly prohibited. Screening activities to identify health risks Health Risk Appraisals (questionnaires) Health Screenings (blood draws and biometric measurements: BMI, blood pressure, cholesterol, fasting glucose) Combining the results of the HRA with biometrics leads to a more precise risk profile. Computerized health risk assessment/appraisals often incorporate biometric data in their risk analysis Interventions: Primary Prevention: address health risks – also referred to as lifestyle management Secondary Prevention: improve control of chronic conditions, also referred to as disease management Environmental Controls Smoking Policies Healthy Food Choices at work Incentives to participate Rewards for maintaining healthy biometric Rewards for improvement and outcomes Source: Rand Study Worksite Wellness Programs

16. Page 16 Recording of this session via any media type is strictly prohibited. On-Site Clinics General education and class interventions One on One – Coaching: o Internet (wellness portal with interactive functions) o Telephonic (most popular with least effort) o Face to Face (on-site presence – meet during work day – Most often tied with on-site clinic (becoming more popular) Trend – Virtual Wellness o Efficient delivery during off hours o Access for most employees o Can easily include dependents & spouses Interventions

17. Page 17 Recording of this session via any media type is strictly prohibited. Workers with identified risks or desire to improve their health habits may be periodically coached via telephone by trained health coaches. Coaching assists employees set and achieve realistic lifestyle-related goals including those addressing stress, work life balance, tobacco use, weight, exercise, and various behavior modifications. Three or more sessions are typically offered In some intensive programs, the coaching extends to actual disease management intervention for employees with identified high-risk diseases. Coaching

18. Page 18 Recording of this session via any media type is strictly prohibited. Digitized Coaching o Wellness Portal o Assigned coach: phone, email, text Wellness Apps o Map my Walk o My Fitness Pal o Fooducate: http://www.fooducate.com/ Connections to Health Provider Monitoring Chronic Conditions 18 Trends – Virtual Wellness

19. Page 19 Recording of this session via any media type is strictly prohibited. ACA – encourages employers to incent for both participation & outcomes (i.e. can create surcharge for tobacco users) Types of Incentives o Cash o Health Insurance Premium discounts or surcharges o Gift cards o Novelty Items (t-shirts, hats, etc.) Does it Work? Yes, but….most effective when value is $50.00 or higher: o HRA: 63 vs. 29% o Screenings: 57 vs. 38% o Some increased participation in behavioral change programs – Smoking: only health risk behavior for which achieving the goal is rewarded with a higher incentive than participation in a program o But does it achieve the ROI of improved health AND expected ROI – reduced healthcare costs? Incentives – Rewards for Participation & Outcomes

20. Page 20 Recording of this session via any media type is strictly prohibited. 50% of current employers with wellness programs incent for participation 10% use incentives tied to health-related standards or outcomes (tobacco use, healthy BMI range) 49% offer incentives directly to all employees (others offer to only benefit covered) 31% administer through group health plans (premium differential). Becoming more popular 20% administer both directly and through their plans (combination of premium differential and other rewards) 2013 Trends for Using Incentives

21. Page 21 Recording of this session via any media type is strictly prohibited. Reduce risk factors (Blood Pressure, Cholesterol, Glucose, Weight) o Risk Reduction must be sustainable and clinically meaningful Key – Effective program design and implementation impact: o Health care costs – impact on premium trend year over year o Decrease use of emergency room, in-patient & other high-cost care o Decrease work days lost to occupational injuries, short term disability o Improved productivity Trends in health care costs and use of high-cost care for program participants and non-participants diverge over time Expected ROI If Done Right

22. Page 22 Recording of this session via any media type is strictly prohibited. RAND Study: What is cost impact of PepsiCo’s wellness program Findings: Seven years of continuous participation in one or both components was associated with an average reduction of $30 in health care cost per member per month Disease management component was associated with lower costs o Reduced health care costs by $136 per member per month o 29% reduction in hospital admissions Lesson learned: Programs may reduce health risks, delay or avoid the onset of chronic diseases, and lower health care costs for employees with manifest chronic disease over long term commitment Employers and policy makers should not take for granted claims cost reduction from lifestyle change programs Journal of Health Affairs - Managing Manifest Diseases, But Not Health Risks, Saved PepsiCo Money Over Seven Years

23. Page 23 Recording of this session via any media type is strictly prohibited. Impact on Biometrics/Health Behaviors  Hypertension reduced by 63%  HDL Cholesterol risk reduced by 79%  Diabetes reduced by 42%  Smoking reduced by 13%  Exercise levels increased by 34%  Increase in hypertensive and lipid lowering medication 16% and 13.8% respectively o Addressing risks with medication avoids catastrophic claims

24. Page 24 Recording of this session via any media type is strictly prohibited. Effective communication strategies Opportunity for employees to engage Leadership engaged at all levels Use of existing resources and relationships Continuous evaluation RAND Study – Critical Success Factors

25. Page 25 Recording of this session via any media type is strictly prohibited. Identify & Reduce: Smoking, Lack of exercise, Excess weight, Unhealthy diet that lead to diagnosis of high cholesterol, high blood pressure, stress, depression & high costs Target high-risk workers and already diagnosed chronic disease for aggressive intervention (short term gains) Direct some efforts towards healthy workers to maintain their low-risk status (long term gains to flatten curve) Emphasize outcomes as opposed to simply offering wellness activities for their own sake Look at cost saving impact across the spectrum: healthcare, disability, worker’s compensation, absenteeism Ideal Strategy – Health & Productivity

26. Page 26 Recording of this session via any media type is strictly prohibited. Unsuccessful Workplace Wellness Program Penn State University – 40,000 employees, spouses and dependents Highmark is the 3 rd party claim administrator and Highmark recommended WebMD Services to administer the Workplace Wellness Program Biometric Screening, visit personal physician for check-up and complete online HRA HRA elicited intimate details about job relationships, marital relationships, including whether female employees planned to become pregnant over the next year, and their finances

27. Page 27 Recording of this session via any media type is strictly prohibited. Unsuccessful Workplace Wellness Program Failure to complete the HRA resulted in a $100 a month deduction from the employee’s paycheck Stick + invasive nature of questions = vocal revolt by faculty and staff PSU decided to suspend the fee for noncompliance and set up a task force to seek faculty input into possible alternatives Are there lessons to be learned from PSU’s approach? Was the Workplace Wellness Program legal?

28. Page 28 Recording of this session via any media type is strictly prohibited. Workplace Wellness Programs Legal Risks Multiple laws and regulations that impose certain prohibitions or limitations for the purpose of protecting employees from employer discrimination, based on a poor health status The universe of laws impact:  Nondiscrimination  Reasonable accommodation  Confidentiality  Protected off-work conduct

29. Page 29 Recording of this session via any media type is strictly prohibited. Workplace Wellness Programs Legal Risks The legal risks include:  Risk of litigation  Risk of breach of privacy  Risk of regulatory non-compliance  Risk of claims of discrimination, etc.

30. Page 30 Recording of this session via any media type is strictly prohibited. The ACA and Workplace Wellness Programs The Patient Protection and Affordable Care Act (2010) promotes Workplace Wellness Programs Final regulations were issued on May 29, 2013, entitled, “Incentives for Nondiscriminatory Wellness Programs in Group Health Plans” Final regulations designed to ensure nondiscrimination in their application and provide comprehensive guidance; programs must be designed to promote health and prevent disease Effective for plan year beginning on or after January 1, 2014 Other federal and state laws remain applicable

31. Page 31 Recording of this session via any media type is strictly prohibited.

32. Page 32 Recording of this session via any media type is strictly prohibited. Participatory Wellness Programs 1.Definition: o Does not require an individual to meet a standard related to a health factor in order to obtain a reward or avoid a penalty o Offers no reward 2.Examples: o Gym membership o Filling out a health risk assessment (HRA) o Attending a health education seminar o Participating in diagnostic testing without the requirement of a specific result

33. Page 33 Recording of this session via any media type is strictly prohibited. Participatory Wellness Programs 3.Rule: o Must be made available to all similarly situated individuals regardless of health status o Availability regardless of health status ensures that the general prohibition against discrimination based on a health factor is not implicated

34. Page 34 Recording of this session via any media type is strictly prohibited. Health-Contingent Wellness Programs 1.Definition: o Requires an individual to satisfy a standard related to a health factor to obtain a reward or avoid a penalty o Two Categories: 1)Activity-only: requires an individual to perform or complete an activity related to a health factor in order to obtain a reward or avoid a penalty, BUT does not require the individual to attain or maintain a specific health outcome. 2)Outcome-based: requires an individual to attain or maintain a specific outcome in order to obtain a reward or avoid a penalty. Generally, have progressive levels: first, a measurement test or screening, then a program targeted at identified health risk.

35. Page 35 Recording of this session via any media type is strictly prohibited. Health-Contingent Wellness Programs 2.Examples: Activity-only Walking Dieting Attending an exercise program Attending a nutrition class Outcome-based Achieving a normal body mass index (BMI) Attending anti-smoking program and discontinuing smoking Attaining certain levels for cholesterol or glucose screenings Meeting targets for exercise

36. Page 36 Recording of this session via any media type is strictly prohibited. Health-Contingent Wellness Programs 3.Rules for Activity-Only Wellness Programs: o A reasonable alternative standard (RAS) must be provided to individuals for whom it is unreasonably difficult because of a medical condition or medically inadvisable to meet the standard. o Examples: Unable to participate in walking program due to recent surgery, pregnancy or asthma. o Individual’s doctor may provide verification on the employee’s medical condition and may suggest a reasonable alternative standard

37. Page 37 Recording of this session via any media type is strictly prohibited. Health-Contingent Wellness Programs 3.Rules for Activity-Only Wellness Programs (cont’d): o A plan or issuer may seek verification from individual’s doctor that a health factor makes compliance unreasonably difficult or medically inadvisable, if reasonable under the circumstances. o Employer may choose to waive the standard and just provide the reward.

38. Page 38 Recording of this session via any media type is strictly prohibited. Health-Contingent Wellness Programs 4.Rules for Outcome-based Wellness Programs: o A reasonable alternative standard (RAS) must be provided to any employee who does not meet the initial standard. o For example, an educational program or activity must be substituted. o An employer cannot require an employee to provide physical verification of a need for a reasonable alternative standard under an outcome-based wellness program.

39. Page 39 Recording of this session via any media type is strictly prohibited. Health-Contingent Wellness Programs 4.Rules for Outcome-based Wellness Programs (cont’d): o If, however, an individual’s physician states that a standard is not medically appropriate for the individual, the plan or issuer must provide a reasonable alternative standard that accommodates the recommendations of the physician with regard to medical appropriateness.

40. Page 40 Recording of this session via any media type is strictly prohibited. Health-Contingent Wellness Programs Reasonable Alternative Standards Generally, the RAS includes modifications and adjustments that allow participant to enjoy the reward. All facts and circumstances are taken into account in determining whether a plan has furnished a reasonable alternative. if RAS is completion of educational program, plan must make the program available or assist employee in finding a program; can’t require employee to find or pay for program time commitment required must be reasonable

41. Page 41 Recording of this session via any media type is strictly prohibited. Health-Contingent Wellness Programs Reasonable Alternative Standards if RAS is diet program, plan must pay any membership or participation fee, but not food if individual’s personal physician concludes that a plan standard is not medically appropriate (even if plan’s medical professional recommended it), the plan must provide a RAS that is consistent with personal physician’s recommendations the RAS must comply with the requirement of the health-contingency category it falls under

42. Page 42 Recording of this session via any media type is strictly prohibited. Health-Contingent Wellness Programs 5.Rules for BOTH Categories of Health- Contingent Wellness Programs: o Give all eligible employees an opportunity to qualify for the reward or avoidance of the penalty at least once a year; o Provide a reward or absence of a penalty surcharge not in excess of 30%, or 50% if the program is designed to prevent or reduce tobacco use calculated on the total cost of coverage (the combined total of the employer’s and employee’s contribution for employee-only coverage) under the employer’s health plan;

43. Page 43 Recording of this session via any media type is strictly prohibited. Health-Contingent Wellness Programs 5.Rules for BOTH Categories of Health- Contingent Wellness Programs (cont’d): o Be reasonably designed to promote health and prevent disease; o Make the full reward available to all similarly situated individuals, which requires provision of a reasonable alternative standard, or waiver of the original standard; and o Reasonably disclose the availability, or possible waiver, of an alternative standard in program materials.

44. Page 44 Recording of this session via any media type is strictly prohibited. What Constitutes a Reward for Participatory and Health-Contingent Wellness Programs Incentive or disincentive For example:  premium discount  rebate on premium or contribution  additional health benefits  modification or waiver of otherwise applicable cost sharing  other financial incentives or avoidance of a penalty  premium surcharge or other financial disincentives

45. Page 45 Recording of this session via any media type is strictly prohibited.

46. Page 46 Recording of this session via any media type is strictly prohibited.

47. Page 47 Recording of this session via any media type is strictly prohibited. GINA Workplace Wellness Programs Other Applicable Laws: The Legal Risk Universe Workplace Wellness Programs Legal Risks ACA ADA ERISA ADEA Title VII State Lifestyle Discrim- ination Laws HIPAA

48. Page 48 Recording of this session via any media type is strictly prohibited. Americans with Disabilities Act (ADA) and Workplace Wellness Programs ADA prohibits discrimination based on disability; however, “[D]isability- related inquiries and medical examinations are permitted as part of a voluntary wellness program.” [EEOC Office of Legal Counsel, 1/18/13] Participation in Workplace Wellness Programs must be voluntary, not forced. Voluntary if employees are neither required to participate nor penalized for non-participation. “EEOC [who enforces the ADA] has not taken a position on whether, and to what extent, a reward amounts to a requirement to participate, or whether withholding of the reward from non-participants constitutes a penalty, thus rendering the program involuntary.” [EEOC Office of Legal Counsel, 1/18/13]

49. Page 49 Recording of this session via any media type is strictly prohibited. Americans with Disabilities Act (ADA) and Workplace Wellness Programs The possibility exists that financial inducements associated with Workplace Wellness Programs could violate ADA if they have the effect of discriminating against employees on the basis of disability. Hearings before the EEOC were held May 8, 2013 where written and oral testimony was submitted; no guidance has resulted.

50. Page 50 Recording of this session via any media type is strictly prohibited. Americans with Disabilities Act (ADA) and Workplace Wellness Programs Litigation: Seff vs. Broward Co., Florida  Class action based on violation of ADA because of penalty for not participating in wellness program  Workplace Wellness Program – Biometric screening and online HRA  Administered by health insurer, Coventry Healthcare  5 diseases identified as health risks with access to coaching program  Reward – Waiver from co-pay of disease management medications

51. Page 51 Recording of this session via any media type is strictly prohibited. Americans with Disabilities Act (ADA) and Workplace Wellness Programs  Penalty – $20 surcharge on each bi-weekly paycheck on those enrolled in health plan but not participating in wellness program  Workplace Wellness Program was HIPAA compliant  Court didn’t decide whether wellness plan was voluntary  Court granted Summary Judgment for County based on ADA Safe Harbor provision, that is, the wellness program was a “term of a bona fide benefit plan”  11 th Circuit affirmed, concluding that wellness program did not have to appear in plan’s written documents to qualifty as a “term”

52. Page 52 Recording of this session via any media type is strictly prohibited. GINA and Workplace Wellness Programs Prohibits employers from requesting or requiring genetic information of an employee or an employee’s family Genetic information means information about:  the individual’s genetic tests  genetic tests of individual family members  manifestation of a disease or disorder in an individual’s family member (Family Medical History)

53. Page 53 Recording of this session via any media type is strictly prohibited. GINA and Workplace Wellness Programs Generally, any reward given for the completion of a Health Risk Assessment that solicits information about an individual’s family medical history violates GINA requirements. GINA limits the ability of employers to implement Workplace Wellness Programs that require employees to provide Family Medical History, as any such disclosure must be voluntary and employers cannot condition receipt of an award on providing genetic information. There are limited exceptions. One is that the employer advises the employee that the incentive will be given for completing the HRA regardless of whether the employee answers the question regarding Family Medical History.

54. Page 54 Recording of this session via any media type is strictly prohibited. Other Federal Laws and Workplace Wellness Programs Title VII of the Civil Rights Act Prohibits discrimination in employment based on race, color, religion, sex or national origin Workplace Wellness Programs cannot discriminate against the protected classes ADEA Prohibits age discrimination in employment Workplace Wellness Programs cannot impact those over 40 more than those under 40

55. Page 55 Recording of this session via any media type is strictly prohibited. State Lifestyle Discrimination Law and Workplace Wellness Programs Many states have lifestyle discrimination laws protecting those who engage in legal off-duty conduct. Some states prohibit discrimination based on any lawful activity by an employee off the premises during non-working hours. (See, California, Colorado, New York and North Dakota) Some states prohibit discrimination based on the employees’ use of “lawful products.” (See, Illinois, Minnesota, Montana, Nevada, North Carolina and Wisconsin)

56. Page 56 Recording of this session via any media type is strictly prohibited. State Lifestyle Discrimination Law and Workplace Wellness Programs Approximately 30 states have laws prohibiting discrimination based on off-duty tobacco use. The State of Michigan has a law prohibiting discrimination against obese individuals. ERISA may preempt state laws under certain circumstances.

57. Page 57 Recording of this session via any media type is strictly prohibited. Workplace Wellness Programs Privacy Employers should treat employee wellness program records as confidential material Use an independent third-party to administer, evaluate and implement Workplace Wellness Programs Treat third party as HIPAA Business Associate and make sure they sign a Business Associate Agreement and that they de-identify all data shared with you

58. Page 58 Recording of this session via any media type is strictly prohibited. BEST PRACTICES 10 WAYS TO AVOID OR MINIMIZE RISK IN THE DESIGN AND IMPLEMENTATION OF WORKPLACE WELLNESS PROGRAMS 1.Implement voluntary Workplace Wellness Programs designed to promote health and prevent disease. 2.Design and implement your Workplace Wellness Plan in developmental stages. 3.Ensure reasonable alternative standards are provided for health-contingent programs for employees for whom it is unreasonably difficult due to a medical condition or medically inadvisable to satisfy a condition.

59. Page 59 Recording of this session via any media type is strictly prohibited. BEST PRACTICES 10 WAYS TO AVOID OR MINIMIZE RISK IN THE DESIGN AND IMPLEMENTATION OF WORKPLACE WELLNESS PROGRAMS 4.Ensure that eligible employees are given the opportunity to qualify for any reward once per year. 5.Ensure incentives are in compliance with ACA percentage requirements and consider using carrots rather than sticks. 6.Clearly communicate your Workplace Wellness Plan criteria to employees and incorporate terms of your plan in all plan materials.

60. Page 60 Recording of this session via any media type is strictly prohibited. BEST PRACTICES 10 WAYS TO AVOID OR MINIMIZE RISK IN THE DESIGN AND IMPLEMENTATION OF WORKPLACE WELLNESS PROGRAMS 7.Engage a third-party administrator to ensure privacy and confidentiality. 8.Engage legal counsel to review your Workplace Wellness Plan to ensure statutory and regulatory compliance and to identify any risks of employee- driven litigation or regulatory enforcement action that may be associated with the terms of your plan.

61. Page 61 Recording of this session via any media type is strictly prohibited. BEST PRACTICES 10 WAYS TO AVOID OR MINIMIZE RISK IN THE DESIGN AND IMPLEMENTATION OF WORKPLACE WELLNESS PROGRAMS 9.Establish reasonable financial and health goals, measure your outcomes and adjust where necessary. 10.Explore the availability of insurance coverage for risks associated with compliance with the ACA.

62. Page 62 Recording of this session via any media type is strictly prohibited. Questions, Final Comments and Contact Information Carol Staubach CA Staubach & Associates 305 E. St. Andrews Drive Media, PA 19063 carols@cstaubach.com Office: 610.891.6034 Cell: 484.431.9357 Eleanor D. Thompson Special Counsel McCarter & English, LLP 1735 Market Street BNY Mellon Center, Suite 700 Philadelphia, PA 19103 ethompson@mccarter.com www.mccarter.com Office: 215.979.3860 Fax: 215.979.3899

63. Page 63 Recording of this session via any media type is strictly prohibited. Disclaimer These slides and the accompanying commentary are provided as general information about Workplace Wellness Programs. The Patient Protection and Affordable Care Act and related laws are complex and comprehensive in their application to Workplace Wellness Programs. This material should not be relied upon as legal advice or as a legal opinion on any specific matter. Please consult legal counsel concerning your particular circumstances or any questions you may have. IRS CIRCULAR 230 DISCLOSURE: To comply with requirements imposed by the Department of the Treasury, we inform you that any U.S. tax advice contained in this communication (including any attachments) is not intended or written by the practitioner to be used, and that it cannot be used by any taxpayer, for the purpose of (i) avoiding penalties that may be imposed on the taxpayer, and (ii) supporting the promotion or marketing of any transactions or matters addressed herein.