TIME Health Care

Health Insurance Sign-Ups Coming to Shopping Malls Starting on Black Friday

Customers shop at a Walmart store in the Porter Ranch section of Los Angeles November 26, 2013. This year, Black Friday starts earlier than ever.
Customers shopping at a Walmart store on Black Friday 2013. Kevork Djansezian—Reuters

Through the busiest shopping days of the holiday season

(CHICAGO) — The Obama administration will promote health insurance coverage at shopping malls starting on Black Friday and continuing through the busiest shopping days of the holiday season, officials announced Wednesday. They said more than 462,000 people selected a private insurance plan in the first week of 2015 enrollment through the online marketplace HealthCare.gov.

The government’s enrollment push with Westfield Shopping Centers will involve setting up outreach tables at malls in Florida, Illinois, New Jersey, Connecticut, Maryland, New York and Washington state. Westfield will post information about enrollment services on its website.

The administration released what it called a snapshot of signups for the first week of the enrollment period, which started Nov. 15. U.S. Department of Health and Human Services Secretary Sylvia Burwell said 462,125 people chose a health plan in the 37 states using the federal website.

Of those, 48 percent are new customers, including enrollees in Oregon and Nevada, which turned over their troubled insurance markets to the federal government. The figures don’t include states running their own insurance markets. The numbers represent only the choice of a plan, and not whether consumers paid their first month’s premium — a requirement for coverage to start.

“We’re off to a solid start but we’ve got a lot of work every day between now and Feb. 15,” the last day of the enrollment period, Burwell said in a conference call with reporters. About 1 million people phoned the enrollment site’s help line, she said, and roughly an additional 100,000 callers chose to speak with a Spanish-speaking representative.

Burwell said the administration is sticking with its previously announced goal of signing up 9.1 million consumers for coverage in 2015.

Unlike last year, the website suffered no outages in the first week, officials said, and it’s ready to handle 250,000 users at a time during anticipated surges around deadlines. Consumers must sign up by Dec. 15 for coverage to start on Jan. 1.

The figures announced Wednesday don’t include dental plans, Burwell stressed. Last week, the administration acknowledged it had been over-reporting the number of enrollees by double-counting about 400,000 who had both medical and dental plans. Burwell said she has directed her staff to find out how the double-counting happened.

Burwell promised a weekly update on enrollment along with more thorough monthly reports that will include what’s happening in state-based markets.

Along with the shopping mall campaign, HHS announced marketing partnerships with the National Community Pharmacists Association and the XO Group, a company that runs websites targeting brides, new mothers and homeowners. The pharmacists group will get enrollment information to its members and pharmacy customers, officials said. The XO Group will post blog content on its sites.

TIME Health Care

Over 450,000 Have Signed Up for Health Insurance

Health Overhaul Version 2
This image shows the website for updated HealthCare,gov, a federal government website managed by the U.S. Centers for Medicare & Medicaid Service. The Obama administration has unveiled an updated version of HealthCare.gov. It’s got some improvements and some challenges. There’s also at least one early mistake. (AP Photo) Associated Press

Compared to 125 last year this time

Over 450,000 people signed up for health insurance via the healthcare.gov website during the first week of open enrollment, the Obama administration said Wednesday.

The Department of Health and Human Services says 462, 125 people signed up for insurance between Nov. 15 and Nov. 21. Nearly half of those enrollees were new customers, Vox reports.

Last year during the first month of the rocky rollout of Obama’s signature health care law, only about 106,000 people signed up for insurance.

Enrollment via the Spanish-language version of healthcare.gov, however, lags. The site has had about 95,000 users since the second enrollment period began.

The release of figures after the first week is a part of an Obama Administration effort to be more transparent about how many people are signing up for insurance via the health care marketplace.

[Vox]

TIME Health Care

VA Ousts Hospital Chief in Phoenix Scandal

As the Veterans Affairs department continues its crackdown in the wake of a nationwide scandal over long wait times

(WASHINGTON) — The head of the troubled Phoenix veterans’ hospital was fired Monday as the Veterans Affairs Department continued its crackdown on wrongdoing in the wake of a nationwide scandal over long wait times for veterans seeking medical care and falsified records covering up the delays.

Sharon Helman, director of the Phoenix VA Health Care System, was ousted nearly seven months after she and two high-ranking officials were placed on administrative leave amid an investigation into allegations that 40 veterans died while awaiting treatment at the hospital. Helman had led the giant Phoenix facility, which treats more than 80,000 veterans a year, since February 2012.

The Phoenix hospital was at the center of the wait-time scandal, which led to the ouster of former VA Secretary Eric Shinseki and a new, $16 billion law overhauling the labyrinthine veterans’ health care system.

VA Secretary Robert McDonald said Helman’s dismissal underscores the agency’s commitment to hold leaders accountable and ensure that veterans have access to high-quality, timely care.

An investigation by the VA’s office of inspector general found that workers at the Phoenix VA hospital falsified waiting lists while their supervisors looked the other way or even directed it, resulting in chronic delays for veterans seeking care. At least 40 patients died while awaiting appointments in Phoenix, the report said, but officials could not “conclusively assert” that delays in care caused the deaths.

About 1,700 veterans in need of care were “at risk of being lost or forgotten” after being kept off the official waiting list in Phoenix, the IG’s office said.

“Lack of oversight and misconduct by VA leaders runs counter to our mission of serving veterans, and VA will not tolerate it,” McDonald said in a statement late Monday. “We depend on VA employees and leaders to put the needs of veterans first.”

Helman is the fifth senior executive fired or forced to resign in recent weeks in response to the wait-time scandal.

Helman did not immediately respond to telephone messages Monday from The Associated Press.

Helman, who has worked at the VA since 1990, has been on paid leave since May 1, shortly after a former clinic director at the Phoenix site alleged that up to 40 patients may have died because of delays in care and that the hospital kept a secret list of patients waiting for appointments to hide the treatment delays.

Dr. Samuel Foote, who had worked for the Phoenix VA for more than 20 years before retiring last December, brought the allegations to light and says supervisors ignored his complaints for months.

Foote called Helman’s dismissal “a good first step,” but said the VA still needs to show it is serious about changing its culture. “I think there are a lot of others who need to follow her out the door,” he said Monday.

In an interview with the AP in May, hours before being placed on administrative leave, Helman denied any knowledge of a secret list and said she had found no evidence of patient deaths due to delayed care.

Helman told the AP that she takes her job seriously and was personally offended by the claims of misconduct. “I have never wavered from the ethical standards that I have held my entire career, and I will continue to give these veterans what they deserve, which is the best health care,” Helman said.

Rep. Kyrsten Sinema, D-Ariz., said Monday that firing Helman was the right decision and long overdue, noting that the director has been paid more than $90,000 since being placed on administrative leave. Sinema called that “a completely unacceptable use of taxpayer dollars that should instead go to providing care for veterans.”

Helman’s dismissal “finally sends the message to our veterans and VA employees that misconduct and mismanagement will not be tolerated,” said Republican Sens. John McCain and Jeff Flake of Arizona.

“The VA has a long way to go to win back veterans’ trust, but today’s action represents a positive step in the right direction,” the senators said.

Glenn Grippen, a longtime VA administrator who retired in 2011, has been named interim director of the Phoenix VA Health Care System.

___

Associated Press writer Brian Skoloff in Phoenix contributed to this story.

TIME

House GOP Sues Administration Over Health Care Law

(WASHINGTON) — House Republicans have sued the Obama administration over steps President Barack Obama took to put his health law into place.

The lawmakers say the president overstepped his legal authority.

The lawsuit was filed Friday against the departments of Health and Human Services and the Treasury.

Republicans voted earlier this year to sue Obama over his actions to unilaterally waive provisions of the law.

Democrats have said any suit would be a political sideshow and waste of money.

The suit comes hours after Obama said he was acting on his own on immigration — further infuriating Republicans.

MONEY Longevity

3 Ways to Have a Happier, Healthier Retirement

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Dan Saelinger—Styling by Dominique Baynes; Hai

You're likely to have a long run in retirement. Maintaining a lively pace is good for your health—and good for your wallet, too.

Better access to and improvements in medical care mean that you’re likely to not only live longer but be healthier as well. On average, Americans are living in good health nearly two years more compared with retirees two decades ago and have compressed the time spent in really poor health to the very end of life, says David Cutler, a Harvard University professor who analyzed health data from 90,000 Medicare recipients from 1991 to 2009.

There’s a financial payoff, as well as a quality-of-life one, to maintaining good health longer. Although your total health care costs rise the longer you live (see the graphic below), your annual outlay is far less when you’re in the pink: Average out-of-pocket spending on medical expenses is $6,000 a year for people in good health, vs. $7,416 for people in poor health, according to data from the University of Michigan Health and Retirement study. That means you can devote less of your annual budget to health care bills and more to activities that make your retirement enjoyable. And fortunately, you have a lot more control over your health and quality of life in your later years than you may think, even if you have a chronic health condition.

The Key Moves

Stick with the pack: The elderly subjects in the New England Centenarian Study are poster children for the behaviors that are associated with healthy aging. Yes, they typically don’t smoke, follow a diet that is heavy in vegetables, exercise regularly, and manage stress with aplomb. Less obvious: Nearly 90% of the centenarians live independently well into their nineties, retire later than average, often do volunteer work, and have active social lives involving daily contact with family and friends. Says Thomas Perls, director of the study: “We rarely see a lonely centenarian.”

Keep on moving: Just how much exercise do you need to add years to your life? Doing something to get your muscles working every day is critical, but it doesn’t have to be a lot—even as little as 15 minutes a day is enough to add years to your lifespan, according to Maria Corrada, an associate professor at the University of California at Irvine who is part of a study of nonagenarians that aims to identify factors that lead to a longer life. A woman who exercises 15 to 30 minutes a day has a 20% decrease in the risk of dying at a given age compared with someone who is sedentary, Corrada says.

And good news for those who have spent a lifetime watching their weight: A little more padding in your later years—up to 30 pounds for a person of average height, but no more—may be beneficial too. The extra pounds provide some protection against falls, Corrada says, helping to prevent breaks in brittle bones.

141120_POWER_WALKING

Don’t worry, be happy: Reports on aging often focus on the problems associated with longevity. Here’s an overlooked piece of good news: Retirees consistently report being happier than younger folks. Happiness, researchers have found, tends to be U-shaped: People start adulthood feeling pretty good about themselves, but then the glow diminishes steadily as the stresses of life pile on, according to a study published by the National Academy of Sciences. At age 50, though, the trend reverses, and people report feeling better as they age; by 85, they are even more satisfied with themselves than they were at 18.

Smart money management helps you further stack the deck in your favor; a recent Merrill Lynch study found that financial security was second only to good health among factors that make retirees happy. After all, if you make it to 100, you’ve more than earned the right not to worry about money.

141120_LIVING_LONGER

 

More great tips from the Ultimate Retirement Guide:
6 Ways to Have a Richer Retirement
4 Smart Ways to Give Your Career Staying Power
6 Moves to Make Your Money Last a Lifetime

 

MONEY Health Care

Why Obamacare Is Making Medicare Open Enrollment More Confusing

Tangle of Stethoscopes
Comstock Images—Getty Images

The time to sign up for an individual health insurance plan overlaps with the annual window for switching your Medicare plan. Here's how seniors can navigate this tangle of health care choices.

This is enrollment season for two huge public health insurance programs: Medicare and the Affordable Care Act health insurance exchanges. For older Americans, the overlapping sign-up periods can lead to confusion and enrollment errors.

Insurers offering Medicare and ACA policies have big money at stake, and consumers are subject to a blizzard of marketing messages. Annual enrollment for Medicare prescription drug (Part D) and Advantage (Part C) plans began Oct. 15 and runs until Dec. 7; shopping for healthcare policies in the marketplace exchanges created under the ACA began Nov. 15 and ends Feb. 15.

Consumer assistance groups report that some Medicare enrollees mistakenly think they must also enroll in the ACA exchanges. And for people with ACA plans who are turning 65, the transition to Medicare can be tricky. Here are some common questions about enrollment overlap, and answers aimed at helping older Americans keep things straight.

Q: What should I do about the ACA marketplaces if I’m already on Medicare?

Nothing. The policies sold on the exchanges are for Americans who don’t have coverage through an employer. And it is illegal for someone to sell you an exchange plan if the provider knows you are covered by Medicare. You can’t buy a Medicare Advantage, Medigap or Part D drug plan through the ACA marketplaces; to enroll in these plans, visit the federal government’s Medicare Plan Finder website.

Q: I bought health insurance this year on my state’s exchange, but I’m turning 65 in December. Do I need to shift to Medicare then?

It’s critical that you move to Medicare as soon as you are eligible. The enrollment window starts three months before your 65th birthday and ends three months afterward.

Failure to enroll will saddle you with expensive premium penalties. Monthly Part B premiums jump 10% for each 12-month period that you could have had coverage but didn’t—for life. That can add up: A senior who fails to enroll for five years ultimately would face a 50% Part B penalty—10% for each year. Penalties also are applied for late enrollment in Part D, under a different formula.

Q: When I shift into Medicare, can I just stick with the company that insures me in the ACA exchange?

You probably could do that; many of the nation’s biggest health insurers operate in both Medicare and the ACA exchanges. But brand loyalty isn’t advised here. Even if you’ve been satisfied with your provider, that company’s Medicare prescription drug plan may not offer the same coverage you had in the exchange. And the Medicare Advantage plan may not include the same network of providers or level of benefits.

Treat Medicare sign-up as a new shopping exercise. For starters, think about whether you want traditional fee-for-service Medicare or Advantage, a managed care alternative. Traditional Medicare allows you to see any health provider that participates in Medicare, but you’ll probably want to add a standalone prescription drug plan and a Medigap supplemental policy. With Advantage, you’ll be limited to in-network providers, but most plans have built-in prescription drug coverage and cap out-of-pocket spending.

Q: I qualified for tax subsidies in the ACA exchanges. Will those continue when I go into Medicare?

No. The ACA subsidies offset premium costs for households in a wide band of income, from 100% to 400% of the federal poverty level. This year that worked out to an annual income of between $11,490 and $45,960 for an individual, and $23,550 to $94,320 for a family of four.

Medicare enrollees can get assistance with premiums if they meet certain income and asset tests through the Medicare Savings Program. Another program, called Extra Help, can offset most or all prescription drug costs. The Medicare Rights Center’s website has a summary of these programs.

TIME Health Care

Obama Administration Boosted Obamacare Numbers With Dental Plans

Obamacare Expedited Bid Process Limited Who Could Build Website
Andrew Harrer—Bloomberg/Getty Images

Says it was a "mistake," having earlier counted dental plans separately

The Obama administration discreetly included dental plan sign-ups in its most recent report on the Affordable Care Act’s enrollment numbers.

The White House claimed in September that 7.3 million people had enrolled in insurance plans under Obamacare, surpassing President Obama’s 7 million sign-up goal. But investigators from the House Oversight and Government Committee analyzed these enrollments and found that as many as 400,000 of the plans were simply for dental coverage, Bloomberg reports. In earlier reports, the administration had counted dental plans separately.

Excluding dental plans, Obamacare enrollment would be around 6.7 million — missing the administration’s stated goal. The Department of Health and Human Services issued a statement Thursday calling the numbers a “mistake”:

A mistake was made in calculating the number of individuals with effectuated Marketplace enrollments. We have determined that individuals who had both Marketplace medical and dental coverage were erroneously counted in our recent announcements. The correct number of individuals with effectuated Marketplace medical coverage as of October 15 is approximately 6.7 million. Our target for 2015 open enrollment remains 9.1 million individuals. Moving forward only individuals with medical coverage will be included in our effectuated enrollment numbers.

U.S. Health and Human Service Secretary Sylvia Mathews Burwell called the error “unacceptable”

Burwell had perviously asserted that the success of Affordable Care Act should be measured by the U.S. uninsured rate, not the Obamacare enrollment numbers, which may fluctuate. The uninsured rate is down about four percentage points to 13.4% over the past year.

 

[Bloomberg]

MONEY Health Care

6 Questions to Ask Before You Sign Up for a Health Plan This Year

tweezers and pill
Geir Pettersen—Getty Images

Employers are changing your health insurance options more than ever. Rushing through your open enrollment paperwork could cost you.

You don’t get a pass this year on big health insurance decisions because you’re not shopping in an Affordable Care Act marketplace. Employer medical plans—where most working-age folks get coverage—are changing too.

Rising costs, a looming tax on rich benefit packages, and the idea that people should buy medical treatment the way they shop for cell phones have increased odds that workplace plans will be very different in 2015.

“If there’s any year employees should pay attention to their annual enrollment material, this is probably the year,” says Brian Marcotte, CEO of the National Business Group on Health, which represents large employers.

In other words, don’t blow off the human resources seminars. Ask these questions.

1. Is my doctor still in the network?

Some employers are shifting to plans that look like the HMOs of the 1990s, with limited networks of physicians and hospitals. Provider affiliations change even when companies don’t adopt a “narrow network.”

Insurers publish directories, but the surest way to see if docs or hospitals take your plan is to call and ask.

“People tend to find out the hard way how their health plan works,” says Karen Pollitz, a senior fellow with the Kaiser Family Foundation. “Don’t take for granted that everything will be the same as last year.” (Kaiser Health News is an editorially independent program of the foundation.)

2. Is my employer changing where I get labs and medications?

For expensive treatments—for diseases such as cancer or multiple sclerosis—some companies are hiring preferred vendors. Getting infusions or prescriptions outside this network could cost thousands extra, just as with doctors and hospitals.

3. How will my out-of-pocket costs go up?

It’s probably not a question of if. Shifting medical expense to workers benefits employers because it means they absorb less of a plan’s overall cost increases. By lowering the value of the insurance, it also shields companies from the “Cadillac tax” on high-end coverage that begins in 2018.

Having consumers pay more is also supposed to nudge them to buy thoughtfully—to consider whether procedures are necessary and to find good prices.

“It gets them more engaged in making decisions,” says Dave Osterndorf, a benefits consultant with Towers Watson.

How well this will control total costs is very unclear.

Your company is probably raising deductibles—the amount you pay for care before your insurance kicks in. The average deductible for a single worker rose to $1,217 this year, according to the Kaiser Family Foundation. One large employer in three surveyed by Marcotte’s group planned to offer only high-deductible plans (at least $2,600 for families) in 2015.

Employers are also scrapping co-payments—fixed charges collected during an office or pharmacy visit.

Once you might have made a $20 copay for a $100 prescription, with the insurance company picking up the other $80. Now you might pay the full $100, with the cost applied against your deductible, Marcotte says.

4. How do I compare medical prices and quality?

Companies concede they can’t push workers to shop around without giving information on prices and quality.

Tools to comparison shop are often primitive. But you should take advantage of whatever resources, usually an online app from the insurance company, are available.

5. Can I use tax-free money for out-of-pocket payments?

Workers are familiar with flexible spending accounts (which aren’t that flexible). You contribute pretax dollars and then have to spend them on medical costs before a certain time.

Employers increasingly offer health savings accounts, which have more options. Contribution limits for HSAs are higher. Employers often chip in. There is no deadline to spend the money, and you keep it if you quit the company. So you can let it build up if you stay healthy.

Don’t necessarily think of HSAs as money down the drain, says Osterndorf. Think of them as a different kind of retirement savings plan.

6. How is my prescription plan set up?

Drugs are one of the fastest-rising medical costs. To try to control them, employers are splitting pharma benefits into more layers than ever before. Cost-sharing is lowest for drugs listed in formulary’s bottom tiers–usually cheap generics—and highest for specialty drugs and biologics.

If you’re on a long-term prescription, check how it’s covered so you know how much to put in the savings account to pay for it. Also see if a less-expensive drug will deliver the same benefit.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

 

TIME Health Care

Don’t Count on Smart Baby Monitors To Prevent SIDS

New "smart" products to monitor babies shouldn't quell parents' fears about SIDS

Parents often rely on home monitoring products to protect babies from sudden infant death syndrome (SIDS), an unexplained death that can happen to seemingly healthy babies, often during sleep. But they shouldn’t, argues a new editorial report in the journal The BMJ.

David King, author of the piece and clinical lecturer in pediatrics at the University of Sheffield, wrote that smart baby monitors and infant wearables provide a false sense of security to parents who use the products to keep their babies safe.

Take Owlet, King says, a U.S. company that raised $1.85 million in April 2014 for a smart sock that could measure babies’ vital signs. Other companies like Rest Devices and Sproutling have advertised similarly smart clothing for monitoring babies’ vitals. The problem, King argues, is that while the companies don’t outright claim that their products reduce the risk of SIDS, parents’ fears of the disorder are responsible for spurring the industry’s growth.

In August, Sproutling co-founder and CEO Chris Bruce told TIME the product was developed out of his own need to incessantly check on his baby to make sure she was still breathing. “I’d get nervous,” he said. “I tried to listen at the door and I didn’t want to wake her up…So I sneak in, I try and listen if she’s breathing, and I end up putting my hand on her and waking her up.”

King writes that devices can be helpful in some circumstances. “Home monitoring may be justified in some situations, such as for preterm infants or infants who need oxygen,” he says. “But in these cases parents and other caregivers should be trained in observation techniques, operation of the monitor, and infant cardiopulmonary resuscitation.” These monitoring products do not require premarket approval by the US Food and Drug Administration (FDA), and King argues that despite the fact that the companies disclose that they are not medical devices, there’s not enough information ensuring parents really know that. He argues that the advertising for these products is confusing.

In the report, King writes:

Owlet states on its website that the device “alerts you if something appears wrong with your baby’s heart rate or the amount of oxygen in his/her body.” Rest Devices claims that its product allows parents to see their “baby’s breathing patterns, in real-time.” Sproutling says that it will let you know “if your baby is sleeping soundly or if something is wrong.” No published data support any of these claims, and because the devices are being sold as consumer rather than medical devices such data are not required. Ideally, manufacturers would be required to undertake observational studies or randomized trials to support any claims they make concerning the utility and efficacy of wearable devices in infants—even if they are categorized as consumer devices.

The American Academy of Pediatrics has already said that home cardiorespiratory monitors shouldn’t be used to reduce SIDS risk.

In response to King’s report, the founder of Owlet Kurt Workman says in a statement sent to TIME: “I have hundreds of comments from Owlet testers and none of them focus on SIDS. They just want to know if something is wrong. That’s what pulse oximetry does in hospitals and in homes worldwide. Parents simply want something that can monitor their child pro-actively (something that video and sound can’t do). As parents we’re tired of monitors that only serve a purpose when we’re awake. We want something that can let us rest easier. That’s the purpose of Owlet and for many parents it is worth the expense.”

Rest Devices, the company behind the Mimo Smart Baby Monitor, also responded to TIME:

Mimo was never designed to be a medical device. It’s worth noting that our founding team did clinically validate our sensors when doing early-stage development of adult respiratory diagnostic devices, and we continued to use that knowledge base once we transitioned to baby and family products. We do communicate to our customers in several different forms that our product is a baby monitor, not a medical device. It’s on our website, it’s on our packaging, it’s in our support tools—including the setup booklet that helps a parent get up and running.

Owlet says nearly 3,000 people have pre-ordered their product and that their technology is more advanced than the research King mentions in his piece. “The bigger point is that technology has progressed and we can now fit a pulse oximeter, accelerometer and even temperature sensors comfortably on a baby’s foot without any cords,” says Workman, adding that the company is creating a product that they will submit to the FDA as a medical device to take home from the neonatal intensive care unit.

“Some professionals have the notion that the less parents know the better, we feel the opposite,” he says. “We also feel that they have the right to know more about their child.”

King says medical professionals should not recommended the products to ease parents’ fears, but should instead recommend methods long known to work, like positioning a child on its back to sleep. But in our new age of tracking ourselves, why not keep tabs on the vitals of our dependent kin? Smart monitoring devices won’t hurt as an extra way for parents to track their children—as long as they’re well aware that doing so won’t alert them to SIDS in their babies.

Sproutling did not respond to requests for comment at publication.

MONEY Health Care

You Won’t Believe Your Employer Can Ask You These Personal Health Questions

Office lamps pointed at pill bottle interrogation-style
Sarina Finkelstein (photo illustration); OsakaWayne Studios (pill bottle); David Malan/Getty Images (office lamps)

When you sign up for health coverage this year, your employer might ask you for a lot of details about your health and your habits. The goal: Cut the cost of your care.

This year, one third of employers will ask workers who enroll in the company health plan to complete a questionnaire about their health, according to the Kaiser Family Foundation. That’s up from 24% of firms last year. The questionnaires, often called a “health risk assessment,” are even more common at big companies; more than half of employers with 200-plus employees offer them.

And as more companies look to control health-care costs with programs aimed at making workers healthier, the stakes for sharing personal details about your health are getting higher.

Last year, Penn State faced a backlash for a questionnaire that, among other things, asked female employees about their pregnancy plans. Workers who refused to fill it out had to pay an extra $100 a month. Penn State later suspended the program.

If you’ve never seen one of these assessments before, here’s what to expect, what happens to the information you provide, and what your rights are.

What kinds of questions can my employer ask?

The questionnaires are crafted to identify current behaviors that may cause costly health problems in the future, says Jillian Fagan of Wellsource, a technology company that creates health risk assessments. Wellsource’s questionnaires cover a long list of topics, including weight and height, chronic illnesses, treatments you’re getting, your willingness to make lifestyle changes, tobacco use, physical activity, diet, alcohol consumption, cancer screenings, hearing and vision impairment, flu vaccinations, stress levels, and depressive symptoms.

Questionnaire writers have leeway about how to pose the questions. For example, Fagan says employers usually don’t want to explicitly ask if you’re depressed. Instead, you might be asked questions like, do you have a social group? Are you married? Do you feel like you’re getting the support you need? How many alcoholic drinks do you consume every week?

You may also be asked about your outlook for the future, how much time you have to relax, your energy level, and whether you’re satisfied with your work-life balance, Fagan says. Wellsource develops its questions based on scientific research and includes links its the underlying medical literature.

Is there anything my employer can’t ask?

Inquiring about your parents’ health would probably violate the Genetic Information Nondiscrimination Act, which prohibits employers from collecting genetic information, says Maureen Maly, employee benefits and executive compensation attorney at Faegre Baker Daniels. A family history of breast cancer, say, could indicate a genetic predisposition.

“Once upon a time, it would get into some questions about family medical history,” says Maly. “Most of these questionnaires will not ask that—and they will usually have a warning saying, ‘Don’t volunteer any information.'”

Can my boss see my answers?

Generally, no. Under HIPAA, the Americans with Disabilities Act, and state privacy laws, employers are prohibited from using health risk assessments for any reason other than for wellness programs, says employee benefits attorney Todd Martin.

Keep in mind that often your employer already has information on your health. If your health plan is self-funded and self-administered—meaning your employer pays the claims directly rather than contracting with an insurer or third party—someone in your office gets your health claims. Your employer is legally bound to maintain a firewall, secure your private information, segregate it from other employment files, and limit staff access, Martin says. Health risk assessments aren’t much different.

And besides, seeing that information could expose the company to a lawsuit if you’re fired or disciplined. “Most employers don’t want to see that information as much as employees don’t want to give it to them,” says Fagan of Wellsource.

So employers usually hire a third party to administer the questionnaires. If that’s a medical provider, that firm is subject to additional privacy rules, says Martin.

That’s really personal! Why is my employer asking me all that?

The goal is to give you a picture of your health and suggest how to do better, Fagan says. “Health risk assessments show you where you’re going to be in five years,” Fagan says. “If we notice that you don’t work out, you’re eating lots of sugar, and your diet is not so great, if you continue down this road, you’re going to have tons of health problems in the years to come.”

Of course, there’s something in it for your employer too—potential cost savings if you stay healthy.

How can knowing more about my health save my boss money?

More than half of large firms surveyed say that they see wellness initiatives as one of the most effective tactics for controlling health-care costs, according to the National Business Group on Health. Such programs can include weight-loss and smoking cessation classes, nutritional counseling, gym discounts, and lifestyle coaching.

With a summary of the answers employees gave on the questionnaires in hand, a company can see, for example, that a lot of workers are struggling to quit smoking (but not who those employees are), which can help it decide whether or not to offer a smoking cessation class (a common perk). To date, however, the research on the effectiveness of wellness programs is mixed.

What’s more, Jennifer Bard, professor at the Texas Tech University School of Law, says she has serious concerns about the privacy risks associated with wellness initiatives.

“It’s not clear how those risks translate into future health,” Bard says. “There isn’t enough information to say that somebody with a particular blood pressure or cholesterol reading or weight is going to have a specific problem. It’s one thing to diagnose someone who is sick, but the science of risk is not as well-developed.”

What else can come of sharing health information?

Your employer can set health-related goals for you. For example, if you’re overweight, your employer can offer a financial incentive for you to lower your BMI. As part of the Affordable Care Act, those financial incentives can be worth 30% of the total cost of plan costs, up from 20% before health reform.

That kind of outcomes-based wellness program is subject to a strict set of rules, Martin says. If your doctor says that you are unable to achieve the goal, your employer has to offer another way for you to earn the incentive.

Outcomes-based wellness programs are growing but not yet widespread. And only 7% of employers say that employees with health risks must complete some kind of wellness program or face a penalty, according to Kaiser.

“The restrictions have made a number of employers want to stay away from outcomes-based programs and focus on the participation-based programs like the health risk assessment,” says Martin.

Can my employer force me to fill out a questionnaire?

Probably not. Only 3% of large firms that offer questionnaires require employees to fill them out, according to Kaiser.

But health assessments, medical screenings, and wellness programs are still a legal gray area.

The Department of Labor says employers can require workers complete a health risk assessment before enrolling in a company health plan, so long as the employer doesn’t deny benefits or change premiums based on the information.

But the Equal Employment Opportunity Commission recently sued three employers on the grounds that their mandatory wellness programs violated anti-discrimination statutes. The EEOC has sued Honeywell over its wellness program, even though the company says it’s voluntary. But employees and spouses who refuse to participate in health screenings face up to $4,000 in financial penalties, which, the EEOC contends, effectively makes the program mandatory.

“It’s helpful for people to know that this is unresolved,” says Bard, the Texas Tech University law professor. “These kinds of wellness programs with a bite, with a financial consequence, are relatively new. Everyone is watching the EEOC lawsuits very carefully.”

That said, if the wellness program is mandatory, you might have little choice. “In my opinion, anyone who chooses not to comply puts themselves at risk for being a test case,” Bard says.

My employer says it’s voluntary. Why should I fill it out?

Health risk assessments are a benefit, says Fiona Gathright, president of Wellness Corporate Solutions, a third-party vendor that administers wellness programs for employers. “We’re trying to help people manage their health, and we’re trying to help people live longer,” Gathright says. “Answer the questions as honestly as you can. If we uncover that you have a risk, we’re going to you help you a manage that risk.”

Still not convinced? More than half of large firms sweeten the deal with some kind of financial incentive, according to Kaiser; 36% of those firms offer a financial incentive worth more than $500.

I’m still uncomfortable with this. What should I do?

Carefully read the disclosures, which usually contain information about who will see your answers and in what form, says Fagan. And ask your own questions

First, who is doing the assessment? An outside vendor, especially one that’s also a medical provider, is best. How is sensitive personal information protected from data breaches?

Second, what information gets back to the employer? Only you should see your individual results. If your employer will see aggregated responses, how big is the sample size? Is there any way you could be identified—say, if you’re the only obese employee at a small firm? There may be rules against reporting results from small groups.

Finally, ask how your employer intends to use the questionnaire. Know ahead of time if you’re just getting information about your health risks—or if you’re laying the groundwork for an outcomes-based wellness program that will ask you to make big changes.

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