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How does GINA affect health risk assessments and disease management programs?
  • A health risk assessment must meet certain criteria in order to comply with the Genetic Information Nondiscrimination Act (GINA).
  • To be complaint with GINA, a disease management program must be available to everyone.

Employers are not allowed to offer a financial incentive for employees to provide genetic information. They are allowed, however, to provide monetary incentive for the completion of a health risk assessment (HRA) that properly addresses questions about family medical history or other genetic information. They can also reward employees for participating in a disease management program if the program meets certain conditions.

Health risk assessments: When offering a financial reward for completing a health risk assessment, an employer must make it clear to employees that the incentive will be available whether or not the employee answers the questions that ask for genetic information.

For example, if an employer offers $150 to employees who complete a 100-question HRA and the last 20 questions ask about family medical history, HRA instructions must make it clear that employees who complete the first 80 questions will receive the $150, whether or not the final 20 questions are answered. This would be acceptable under GINA.

However, if the instructions did not indicate which questions requested genetic information, nor made it clear which questions must be answered in order to obtain the $150, the HRA would violate Title II.

Disease management programs: Employers can also offer financial incentives to encourage employees to participate in disease-management programs and other programs designed to promote healthy lifestyles or meet particular health goals.

To comply with GINA, these programs must be offered to all employees, not only to those whose genetic information indicates they are at increased risk of acquiring a health condition in the future. This means workers who have current health conditions or whose lifestyle choices put them at increased risk of developing a condition must also be allowed to participate.

For example, an employee who discloses a family history of diabetes on an HRA and another employee who currently has diabetes are both offered $150 to participate in a diabetes management wellness program. The program offers additional financial incentives for employees who achieve certain health outcomes, such as lowering their glucose levels or losing weight. This type of program would be acceptable under GINA.

Note, however, that any program requiring employees to meet a particular health standard in order to receive a reward must meet the Health Insurance Portability and Accountability Act's (HIPAA) nondiscrimination requirements.