Memo - AMERISAFE



[pic]

To: All Employees Eligible for Insurance Benefits

From: Benefits Department

Date: December 14, 2016

Re: Notice Regarding Wellness Exam

Participation in the AMERISAFE, Inc. Wellness Reimbursement initiative is voluntary and available to only those employees enrolled in the AMERISAFE, Inc. Medical Plan. Wellness exams are administered according to federal rules permitting employer-sponsored wellness initiatives that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in the wellness initiative you will be asked to complete an age-appropriate preventive exam (i.e. annual physical, needed bloodwork, well woman exam, etc.) with your physician. You are not required to complete an age appropriate preventive exam (i.e. annual physical, needed bloodwork, well woman exam, etc.).

Employees who are enrolled in the AMERISAFE Group Medical Plan, that choose to participate in the annual wellness exam initiative will receive a $115 annual premium reimbursement for completing an age-appropriate preventive exam (i.e. annual physical, needed bloodwork, well woman exam, etc.). Although you are not required to complete an age-appropriate preventive exam, employees who do so and who are enrolled in the group medical plan at the time the reimbursement is processed, will receive the $115 annual initiative.

Information regarding your wellness exam will not be collected by your employer.  The Benefits department will receive, from you and/or your physician, a completed Wellness Certification Form confirming that a wellness exam has been conducted, but will not have access to the results of the exam. 

Protections from Disclosure of Medical Information

We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness initiative offered by AMERISAFE, Inc. for participation in a wellness exam may use aggregate information collected to design a program based on identified health risks in the workplace, AMERISAFE, Inc. will never disclose any of your personal information publicly or to any other party, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness incentive, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness incentive will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment. Please note: AMERISAFE, Inc. will not receive any medical information or results from your physician in regards to the preventive exam.

Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness incentive, and you will not be asked or required to waive the confidentiality of your health information as a condition of receiving the incentive.   The only individual who will receive your personally identifiable health information is your primary care provider as part of your age-appropriate preventive exam (i.e. annual physical, needed bloodwork, well woman exam, etc.). AMERISAFE, Inc. will not contact your primary care provider to solicit information related to your age-appropriate preventive exam (i.e. annual physical, needed bloodwork, well woman exam, etc.).  As always, under HIPAA, your primary care provider may not disclose your protected health information “PHI” without your authorization.

You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness incentive, nor may you be subjected to retaliation if you choose not to participate.

If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact Rebekah Fontenot at 337-460-3675.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download