company gives employees 6 months to “fix” their health issues

by Alison Green on February 25, 2021

A reader writes:

I’ve worked in HR for 15 years, striving to be the seemingly elusive good HR. I’ve administered wellness programs in a couple of different workplaces and the main purpose has always been engagement – you want people to feel good about taking care of themselves and to be as healthy as they can be. Recently, my sister brought up a facet of her company’s wellness plan that made me feel … gross.

Her company brings in a vendor to do biometric screening, which is great, but here’s where they lose me: her HR department reviews results, determines who is “fine” and who is not, gives those who are not a period of six months to “fix” issues, and then uses this to determine who gets employer funding in their HSA. Not like $25/month funding either, they do the annual max for the employee’s enrollment type.

I feel strongly that HR shouldn’t have personal health information on their employees unless it’s necessary and job-related. To me, this is a complete overreach of things HR should be involved in or have access to. I also don’t think compensation should be tied to things that are potentially genetic and sometimes outside of a person’s control.

My sister argues that it’s a good cost-control measure for the company since the HSA amount is so generous. She thinks that they shouldn’t reward people who aren’t even trying, and says it’s no different than assessing a premium increase for smokers.

I keep thinking of scenarios where this could turn into a discrimination issue. What if a previously healthy woman gets pregnant, ends up with hypertension and gestational diabetes, and they deny her the money? What if someone of a certain ethnic group has a genetic condition that they are under physician’s care for, but can’t completely alleviate? Maybe the program has certain exceptions to allow for these situations, but I don’t have all of the specifics.

I am wondering if this is common practice/legally kosher or if there is a real issue with her company’s wellness program. More to the point, which sister is right?

You are the winning sister! It’s almost certainly illegal, and probably in a few different ways.

* The Americans with Disabilities Act (ADA) prohibits employers from requiring employees to undergo medical exams. It makes an exception for exams conducted as part of a wellness program only if they don’t use the screening to discriminate against employees and only if the program is voluntary and the employer doesn’t penalize people who don’t participate. The law does allow employers to offer incentives for participation if the reward is nominal. Funding someone’s entire annual HSA is not nominal.

* To comply with the ADA, wellness plans must give disabled employees equal access to the program’s benefits, and employers can’t require people with disabilities to complete additional requirements to obtain equal benefits. The plan in your letter doesn’t sound like it complies.

* The ADA also puts significant limits on how much info an employer can request about an employee’s disability. One of those limits is that wellness programs that request health information must be “reasonably designed to promote health or prevent disease.” The law says a program does not meet that standard if it exists to shift costs from an employer to employees based on their health; is used by the employer only to predict its future health costs; or imposes unreasonably intrusive procedures, an overly burdensome amount of time for participation, or significant costs related to medical exams on employees. There’s a good chance your sister’s company’s program is in violation of this.

* The Genetic Information Nondiscrimination Act (GINA) prohibits employers from requesting genetic information from employees. GINA provides an exception for wellness programs only if the employee provides “prior, knowing, voluntary and written authorization”; there is no penalty for not participating; only the employee and licensed health care professional or counselor receive individually identifiable information concerning the results of such services (ahem); and genetic information isn’t disclosed to the employer except in aggregate terms. The program at your sister’s company violates most of this.

* Finally, wellness programs can reward employees for participating in the program — for example, doing things like getting a health screening or joining a gym. But if they tie rewards to achieving specific health outcomes, that can easily end up discriminating based on health status.

And even aside from this cornucopia of legal problems, the program at your sister’s company is a complete paternalistic overreach. Employers shouldn’t be involved in people’s individual medical decisions. Providing health insurance doesn’t make them doctors, and it definitely doesn’t make them their employees’ doctors.

We’ve ended up here because of our ridiculous system of tying health insurance to employment (which is probably in the top 10 worst decisions in the history of the republic), but this is way over the line.

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    2. Detritus*

      I shared it with my friend with MS and she guffawed big time. “If only that’s all it took to ‘get better’!!”

      2. JM in England*

        It makes me wonder if TPTB at this company think that an amputee’s missing limb will grow back in 6 months! The people who perform disability benefits assements here in the UK certainly seem to…

    3. Lady Meyneth*

      Disabled person here. This would be my hill to die on, and I’d make sure the death was spectacular! I’d sue this company so hard, spread word of this to newspapers, badmouth them in the industry, everything. They wouldn’t even know what hit them. My skin is literally crawling over this!

    4. Tangerina Warbleworth*

      Person with hereditary chronic illness covered by the ADA here. You may not have words, but I sure do:

      “Fix THIS, buttheads!!” with a certain finger of each hand raised in salute

        1. Withheld*

          The penalties at Honeywell have increased since 2014. The fees were waived for 2021, but in 2020 there were $500 employee and spouse surcharge penalties for skipping the Biometric Screening and $1,500 employee and spouse surcharge penalties for tobacco use (or skipping the required tobacco blood test).

          If you don’t get screened by the deadline, you may be subject to surcharges:
          • $500 biometric surcharge (each insured – employee and spouse)
          • $1,500 tobacco surcharge (each insured – employee and spouse)

          1. Withheld*

            I should add that Honeywell was also providing incentives if your BMI was above a certain level and you hit goals.
            ———————————————
            Employees and covered spouses enrolled in the Honeywell medical plan who have a Body Mass Index BMI) result of 35 or greater at their last screening are incentivized to reduce BMI by at least two points.

            2019 biometric screening results serve as the baseline against which 2020 biometric screening results will be compared for future wellness and incentive programs.

            Surcharges / incentives apply to employees and covered spouses. The maximum surcharge / incentive is $1,500 per individual or $3,000 for both employee and covered spouse.

          2. pancakes*

            Gross. In reading up on the company just now I’ve also learned they’re one of 60 top US companies known to shield profits abroad to avoid taxes, and that they manufacture maiming weapons like cluster bombs.

          3. Database Developer Dude*

            Wait…employee…..and SPOUSE?!?!?!?!?!?!?! ARE YOU FREAKING SERIOUS???? The company penalizes employees for what their SPOUSE does or doesn’t do?????

    1. Nea*

      Isn’t it? I’m so glad Alison brought up the ADA because I’m permanently disabled and there’s no way in hell I’d be able to “lose the weight” – which all things wrong with me are blamed on of course, despite family history – because I cannot do intensive exercise. On bad days I can barely WALK!!

      1. Lady Meyneth*

        Same. The ONLY exercise I’m allowed to make is light yoga. I tend towards underweight, so no problem there, but my muscle tone is laughable and it’s never going to be anything better than laughable. If my job took exception to it, or any other of the tens of consequences of my disability, I’d be So. Pissed. Off.

        1. ValkyriePuppy*

          And I bet people LOVE that too. I have a friend who’s underweight due to health issues and hates that people will compliment her for it and she’s like “but… I’m fucking unwell, my being this thin is not a sign of my virtue or hard work”. It’s bloody ridiculous how much we pathologize bigger bodies just on the basis of size.

          1. Just Another Zebra*

            My mom has a major issue with digestion of fats, so she tends towards being lean. People used to compliment her on her weight loss until her form answer became “if I ate that, my organs would start to digest themselves”. And then, on the flip side, I have a genetic condition that makes my joints unstable – exercise is not happening. This would have me up in arms.

    2. SqueezyCheese*

      I guess employees with chronic illnesses don’t qualify for the company HSA?

      Somewhere, an employment lawyer just started salivating and she doesn’t know why.

      1. Pippa K*

        LOL at that last line :-)

        And yeah, this is so clearly a company saying “we’re going to give people with healthy bodies more money. Unrelated to the quality of work they do, you understand. It’s just that as a company, we feel that people with any sort of disability or health complication are of less value.”

        I hope they get sued into an alternate dimension.

        1. Marzipan Shepherdess*

          “I hope they get sued into an alternate dimension”? Why, what do you have against that poor, innocent alternate dimension? ;> They surely don’t deserve to have this batspit-crazy company land in their universe!

          But seriously, this is the worst wellness idea I’ve heard in many a moon. This company is indeed cruising for a lawsuit, a million dollars’ worth of bad publicity and blowback out the front door! I really hope that their legal department can get through to them about the financial and reputational dumpster fire that this policy is going to be before they go any further. And yes, of course, my real concern is for the employees being discrimminated against, but “lawsuits” and “bad publicity” are the only points likely to make people like them sit up and listen.

        2. Solana*

          Huh, I didn’t know my old DM had gotten a new job. (He didn’t like people with health issues or who didn’t kiss his posterior. He made my life a living hell when I finally got diagnosed with my fibro and was dealing with all the fun symptoms with it. He was also a coward who was terrified of lawsuits, and who lost a few.)

          But yeah, they’re still looking for a cure for mine. My university is working on it, but not in my specific area. (Dang.) I wouldn’t be getting better in six months. Some days I can walk and work just fine, this morning I was dry heaving and dizzy and walking very slowly. My thoughts on what this company can do with this policy are biologically improbable and would get me banned.

          1. Blomma*

            The CEO/owner at my former toxic job saw me wearing a wrist brace one day. I was wearing it for my fibro, but hell would have to freeze over before I told him (or anyone else at that job) that. He asked me about it and I said it hurt and made a vague reference to carpal tunnel. He said that I needed to get it dealt with because as long as the issue was causing me pain, it would slow me down, and I would make him less money. I *think* he thought he was being funny. I didn’t laugh.

            1. Solana*

              Gross. I’m glad that that job is ‘former’, and that sounds like Schrodinger’s Bully.

              My current one is great with it. I actually just got a promotion where they reduced the hours a bit just for me. (I work with lab animals, and I’m learning some medical things to help the vet techs with ‘easy’ tasks.) I joke that part of it is that one of my researchers would raise Cain if I left the biohazard animals to someone else, and I’m one of the best at getting the autoclave machine to behave.

              1. Blomma*

                I’m glad you’re in a good situation now too! I told my current job that I’m chronically ill, but only indicated that I have a type of arthritis (I do) and didn’t mention the fibro. They’ve been great so far about accommodations!

              2. JustaTech*

                A good animal tech is worth their weight in saffron – one who’s good with and comfortable in the biohazard? Worth their weight in diamonds.

                1. Solana*

                  Thank you. :) I was actually jealous when a friend was being trained in ABSL-3. (My room is ABSL-2). I love biohazard, especially as both of my labs are working on cancer research and I’ve had many people in my life affected by it. It reminds me of cell biology in school. I’m getting to be good friends with one of the researchers. She’s liked me since the first time she walked in when it was under my command and saw the extra box of Swiffer pads, as I’m a bear about having everything stocked and ready to go at any time. I’m also the only one who actually likes it, but I’m weird.

                  I tell everyone that biohazard doesn’t scare me because I’ve cleaned up worse in retail bathrooms, and at least here I have proper PPE. :D

      2. emmelemm*

        Right, person who most needs expensive health care gets least money allotted for health care. Makes complete sense!

      4. Liz*

        Exactly. Not every “health issue” is fixable. For example, high cholesterol. I am blessed with a decent level, but i’m overweight and have mild hypertension. My dad, who was heavy, had pretty bad hypertension (was also a smoker) had a very low level too. Like under 150.

        Yet I’ve known many who are healthy, eat very well, exercise regularly, are not overweight at all, and theirs is through the roof due to genetics. If that were me, and my company tried to pull something like this, i’d be LIVID.

      1. HR Sister*

        You’re taking a summarization of a comment someone you don’t know made, when you don’t know all the context and detail. She has had her own health issues, and she is uneducated about this situation because she is taking what the company is telling her at face value. If only everyone on this planet had made just one uninformed comment that gave someone else the power to label them a bad person. I guess you could be the judge. My question was about the legality of the program, not whether my sister is a dumb@ss.

        1. Middle Aged Lady*

          Maybe one thing you could say to help your sister understand, besides the great points AAM made, is this: when well-meaning people put the pressure on those they think aren’t trying, they believe it’s a motivator for that person. But for many of us, it has the opposite effect and is actually a demotivator. Imagine being fat all your life and at 50, having some chipper youngster tell you to just try harder? And btw, if you don’t, you’ll be punished! That would not make anyone in that position want to try harder. It would make them want a candy bar. Best of luck and thanks for being good HR.

          2. Tidewater 4-1009*

            Also “fat” is relative, many people are naturally curvy. I’m underweight and wish I had that problem. Our clueless culture prizes thinness but it shouldn’t, it should celebrate normal-to-curvy weight.
            On the one or two occasions I had clueless women ask how to be as thin as I am, I was offended because people of normal weight don’t have anxiety about whether they’re going to waste away and die… I would love to be more curvy.

            1. Batgirl*

              I’m technically obese but doctors don’t care because I don’t look it. When I’m extremely, can’t pinch anywhere, thin I’m still classified as overweight going by the doctors algorithm (I don’t know why! Adamantium bones, hopefully). Occasionally the doctor will tell me I should lose weight to meet their criteria, other times they look confused and say it’s fine because of my waist measurement; it’s just so clearly absolute bollocks. People are different shapes and sizes and it’s incredibly dangerous to attach a judgement of what kind of medical help they deserve to that.

              1. Jules the 3rd*

                Waist measurement is a *much* better indicator of risks than weight. People with lots of muscle almost always end up ‘overweight’, and people who are unusually tall / short or with dense bones often do. BMI (Body Mass Index, the common ‘weight to height’ measure) is supposed to compensate for unusual heights, but it doesn’t do it well, and it fails completely at including muscle / bone density.

                1. Batgirl*

                  Very validating, thank you and wonderfully intriguing…. Well possibly they weren’t expecting to weigh bones… I’m sure they were expecting the patient’s skeleton to step outside for a moment.

                2. Ryn*

                  BMI was invented to justify eugenics and is incredibly racist and it’s ridiculous its still used at all.

                3. Quill*

                  Unfortunately BMI turns out to be about as scientifically useful as the wolf study that brought us the idea of the “alpha” wolf, due to it’s many sampling problems.

                  And yet both still persist.

                4. Sleeping Late Every Day*

                  Yeah, unless you have my waistline, which is bizarrely large due to too many necessary surgeries in that area. Add post-menopausal hormonal changes to the bulginess, and you’ve now got age discrimination mixed into the buttload of legal problems this non-wellness plan is accruing.

                5. Just Another Zebra*

                  I loathe BMI with a passion. Based on my age and height, my ideal weight range is 85-105lb. I’ve been that weight (when I was 17 and an all-star cheerleader and burning 2000 calories a day). It’s not a reasonable weight for someone who’s thirty and had a child.

                6. JustaTech*

                  Ugh, everyone needs to stop applying BMI to individuals. BMI is for evaluating *populations* and public health researchers (should) know that it has no nuance at all, and therefore shouldn’t be applied to individuals for all the reasons listed here, and more.

                  Did anyone see the news bit about the guy in the UK who was offered an early COVID vaccination because of his “very high” BMI? Turns out someone mis-typed his height as 6.2cm (about 3 inches) and the computer calculated a BMI of like 200. (The medical records system should have flagged this as impossible.)

                2. TardyTardis*

                  I thought I had, till I flunked my bone scan last spring. It seems I inherited one grandma’s bones and not the other (granted, the first grandma lived to be 97, so hey).

            2. Kristi*

              I’m usually low to moderate weight and also have chronic depression that occasionally flares up into acute horrible almost unendurable depression. When that happens I can lose weight very quickly. A friend (who incidentally is on the low-to-moderate weight spectrum) at one point noticed I was suddenly swimming in my clothes (and too depressed to buy new ones), asked my ‘secret’ and then when I explained, exclaimed “wow, you’re so lucky!”

              If I’d had the energy to kill her…

            3. Liz*

              That would be me. I’m also overweight but even at a “good” weight for my height, age etc., I’m still a double digit size. I will never be anything but that. I’m just not built like that. no matter what I do. Everyone is different

        2. Batgirl*

          Whenever people give advice they should always remember that the reason they’re being asked is because they have a removed perspective. It’s always easier to see what others should do. If I trusted my company and they’d never let me down, I wouldn’t go looking to poke holes in an idea as soon as I heard it.

        3. wee beastie*

          I am sure her sister is lovely and smart—this isn’t on or about her. It feels to me like the company is gaslighting and/or brainwashing their employees. Wooing them with the promise of a fully funded HSA into thinking this is a reasonable ask, and they are buoyed by our very ableist, anti-overweight culture. That company is gross, abusive, overreaching, and discriminatory.

    4. Librarian1*

      Right? This is horrible. What does “fixing” an issue even mean? I can manage my mental illness, but I can’t get rid of it, I’ve been trying for nearly 20 years. I can’t fix my hearing loss, that’s permanent. Yikes.

    6. Wenike*

      I’m wondering if the sister isn’t understanding a fundamental aspect of the program or if my company’s wellness program is problematic. We get the health screening and if you’re in the healthy limits for cholesterol, A1C (or in a diabetes management program if off) and waist size, you don’t need to do anything more but otherwise they want you to work on programs to fix those issues and you get points for finishing them and what you need to do is determined by what issues you might have. It makes me wonder if OP’s sister’s company is similar and someone badly explained it as “fixing” the issues rather than working on them?

      1. allathian*

        I still think it’s utterly out of line for the company to ask employees to work on such programs. Sure, they can provide programs and even encourage people to attend them, but they can’t penalize people for declining to attend.

      2. Jane*

        Yeah, I don’t participate in even the most nominal health screenings with my employer, on principle – and the couple hundred dollars can go to hell. If I wanted a couple hundred dollars for subjecting myself to bureaucratic hoop jumping I’d do some minor credit card churning or something.

        And I would be horrified and consider it discriminatory if I encountered something like your company does. I manage my health separately, thank you vary much. Sharing a bunch of info with some random program my employer chose, AND being required to do more of it than someone who was healthier to receive the same award would read as quite discriminatory to me.

      3. Jane*

        Yeah, I don’t participate in even the most nominal health screenings with my employer, on principle – and the couple hundred dollars can go to hell. If I wanted a couple hundred dollars for subjecting myself to bureaucratic hoop jumping I’d do some minor credit card churning or something.

        And I would be horrified and consider it discriminatory if I encountered something like your company does. I manage my health separately, thank you vary much. Sharing a bunch of info with some random program my employer chose, AND being required to do more of it than someone who was healthier to receive the same award would read as quite discriminatory to me.

      4. pleaset cheap rolls*

        “otherwise they want you to work on programs to fix those issues and you get points for finishing them and what you need to do is determined by what issues you might have. ”

        This is problematic if there is any kind of negative consequences of not doing what they want.

        1. Deborah*

          I mean it’s SLIGHTLY better than the OP’s situation in that they don’t expect you to be successful, but they’re still making people with health issues participate in time-consuming programs against their will, which STILL seems like it would have most of the same legal (and moral!) issues as the OP’s company.

  3. arcya*

    Nonsense like this is why I’ve developed a twitch whenever I hear the word “wellness” in any context tbh

    2. Mallory Janis Ian*

      Right? Like, “wellness” has almost become code for “busybodies up in your business”.

    3. AGD*

      Yep. In my experiences lately, this means at best borderline pseudoscience. At worst, micromanaging nonsense.

    4. Sandi*

      Our workplace decided to refer to our sick leave as a Wellness Program (a reasonable, legitimate one) and I hate the name because I feel like it is painting something good with the soul of evil.

  5. Crivens!*

    I’m going to push back on biometric screenings being “great”, too.

    They’re invasive, they often can’t tell you anything significant about the individual*, they can result in triggers for EDs and dysphoria**, and they’re often used against employees when it comes to their insurance costs.

    * Example: every year without fail a biometric screening that includes a blood draw gets me flagged as having HIV. My GP and every doctor I actually work closely with knows that I get false positive tests for the ELISA, which is what those screenings are usually running, but I am not HIV positive. But every year, I then have to argue with my insurance about this. Because of the biometric screening.

    ** BMI is useful for populations, perhaps, but often not useful for the individual. Telling someone their BMI is “too high” without knowing anything about their general health can do a lot of harm.

    1. Charlotte Lucas*

      I am a short woman with extreme curves. Even at my thinnest, my BMI was high. I’d have to be an unhealthy weight or get part of my anatomy surgically reduced to have a “desirable” BMI.

      1. PT*

        I’m the opposite, I’m tall and lanky and my BMI is below the bottom of the BMI chart. I don’t have an eating disorder, I’m not a health nut, I don’t need to “just eat a burger.” My health is perfectly fine, I take after my grandmother and my great-grandfather, I am just tiny and please leave me alone!!!

        1. Charlotte Lucas*

          My sister’s like that (we take after different grandparents). People probably used to think that my parents gave me all the food. (Nope. She ate twice as much as I did but had that fast metabolism.)

      2. Red Reader the Adulting Fairy*

        Yuuuuup. My doctor’s charting program automatically spits out what it thinks my weight should be, based on my height, which is functionally the same thing as analyzing by BMI. The first time I was there I saw it – she didn’t bring it up – and was like “So, uh, which leg would you like to discuss amputating? Because that’s the only way I’m hitting that weight, I haven’t been that weight since I was about 12, I started looking a little on the unhealthy side about ten pounds above that weight, and it doesn’t actually matter because I’m not entertaining discussions on my weight unless these pants that I am wearing right now stop fitting me and I have to go pants shopping.”

        She was like “Yeah, we can’t make the software stop printing that out, but BMI is crap, I definitely won’t be bringing it up, and I’m totally down with using whether your clothing fits comfortably as a benchmark.” I said good, because I didn’t want to go DOCTOR shopping again either if I didn’t have to.

        2. Clorinda*

          I actually found a doctor who doesn’t weigh me. I told him, I can’t know that number, it makes me crazy, and he agreed not to bring it up unless I start noticeably and rapidly moving from one weight class to another, either up or down.

          1. CoveredInBees*

            My midwives’ office would weigh you at pregnancy checkups as it was medically relevant but wouldn’t say a word unless they had a concern. Also, it was a digital scale so it wasn’t like they were sliding those weights right in front of you. It was great.

              1. NotQuiteAnonForThis*

                My OB’s office offered this option/suggestion with an explanation that they fully understood that sometimes “weight” was a trigger or concern of their patients, and they wanted to both do the best by their patient while getting relevant medical information (because it is something they keep track of).

        3. role model in progress*

          just wanna say, I love the framing of shopping for a doctor like one shops for pants. It’s helping me rethink my hesitancy towards finding a doctor; I don’t have to stick with the first one I try, I can keep shopping around until it’s a good fit.

          (shoving the hassle of insurance and overall cognitive pain of evaluating too many choices into a cupboard for now)

          1. Red Reader the Adulting Fairy*

            I love shopping. But I hate shopping for pants, I hate shopping for doctors, and I hate shopping for car insurance. I will absolutely avoid doing any of them as long as I possibly can, and if it comes to a point where eating more salad and fewer cookies is what I have to do in order to put off the pants shopping, then bring on the aerogarden full of lettuce. (I didn’t doctor shop until my previous doctor moved out of state, and I didn’t car insurance shop until the company I was with decided to literally double my premium after I was pancaked at a stop light by a texting teenager who didn’t notice he was speeding mommy’s car toward a line of stopped traffic. Like, the EPITOME of not-at-fault here.) But as long as my pants fit, I don’t care. (I am enjoying the aerogarden full of lettuce, but mostly because it lets me joke-yell things at my husband like “I don’t grow lettuces for just anybody, you ingrate!”)

            But yes, if you have the flexibility to be able to evaluate and the spoons to keep trying, you absolutely can – and should – keep looking if your doctor is a bad fit. <3

        4. Zephy*

          I saw an article recently about a man in the UK who was called to get his COVID vaccine, as he was identified as being in a high-risk group due to his weight…because someone somewhere recorded his height as 6.2 cm instead of 6 foot 2 inches, which combined with his average-for-someone-that-tall weight, spat out a BMI of 28,000. Certainly the doctor’s office just ran a report of all patients with BMI over a certain value (probably 35 or 40), without looking at the actual value reported.

          1. Doc in a Box*

            Ah, ye olde imperial/metric failure.

            I work with a mostly geriatric patient population (in a subspecialty clinic), and for reasons I don’t understand, we are required by law to weigh our patients, yet we ask them their height instead of measuring, so everyone says the height they were at age 20, not the height they are now, at age 82. Yet another reason why BMI calculators are garbage-in-garbage-out.

        5. Blj531*

          Love this reply.

          I am obese enough that it is medically relevant but went so it or shopping after a doctor brought it up when I had strep.
          My new doctor waited until my second physical and then was like, let’s do the blood work, these things running your family, would you care to see our specialist. I am never ever going to be the I ideal weight and he was careful to say that want a needed goal.
          Am willing to discuss if my numbers can be better health wise am not here for BMI or blaming strep on fat.

      3. Lady Meyneth*

        My husband wass a college rugby player, and he never lost the build. He’s very short, but built like a wall, very muscled all over. And his BMI reads morbid obese.

        What’s most absurd, he needed a specialist last year, and they did the first consult over video. This “doctor” insisted his problem would clear right up if he wasn’t so obese. He continued to insist he just needed to lose weight, even after hubby actually showed his six-pack. The actual diagnosis, after changing doctors? A thyroid issue, pretty easy to treat.

        1. Littorally*

          Yeah, a gym rat friend of mine gets similar treatment. He’s built like a brick — which is to say, broad and square, but no pudge to be seen! And yet, BMI calls him obese and health professionals more obsessed with numbers than what’s in front of their faces will insist he needs to lose weight.

        2. JSPA*

          It’s not safe to assume that heavily muscled is automatically good health for everyone, either, though. A friend of mine was told that [exact details of heart chamber size and wall thickness not relevant here] meant that his heart was overtaxed by his wall-of-muscle mass, and that he was flirting with a sudden cessation of heart function (or maybe it was an aortic dissection?) if he continued to pump massive weights. He switched to long walks, dropped some 40 lbs of arm, chest and abdominal muscle, and is alive and well some 25 years later. Which isn’t to raise a cheer for BMI, but to further drive home the point that nobody but you and your chosen doctor(s) have much business trying to game out what shape and behavior are appropriate for your particular biology.

          1. Lady Meyneth*

            That’s true, which is why bodybuilding is such a dangerous sport if it’s not done right. My husband is pretty healthy, fortunately, and actually does only normal gym exercise and some jiu jitsu. He’s just blessed with easy to maintain muscles, I guess.

        3. Hamish*

          Yup. 5’2″ former powerlifter here. I don’t think I’ll ever not be “morbidly obese”. Last time a doctor mentioned it I asked if he wanted to see who could do more push ups. He did not.

        4. Selina Luna*

          A funny thing about that for me is that I was diagnosed with a thyroid problem because I said to my doctor that I had lost 40 lbs. I also had tremors in my hands and a super, SUPER high blood pressure that I was told by a different doctor was due to my weight.

          Nope, I had a major thyroid issue that wound up requiring the complete removal of my thyroid.

      4. Spicy Tuna*

        I eat plenty and I don’t even look skinny but my BMI is firmly in the “underweight” category. So, yeah, not a good measure of anything

    3. Ray Gillette*

      Oh hey it’s time for my regularly scheduled grumble about how the BMI was originally designed as a statistical tool to study populations and was never intended to be a measure of individual health

      1. Red Reader the Adulting Fairy*

        You are singing the song of my people. BMI on an individual level makes me ragey.

      2. nona*

        And it was designed 200 years ago. And even it’s “measure populations” goal is rooted in racism. BMI is absolute crap.

        1. Quill*

          Even absent… everything else…

          The study involved a population that was predominantly male, from a very specific location, and in a time when there were a lot of factors that could lead to people growing to adulthood with lower muscle or bone mass (improper nutrition, various contagious diseases including tuberculosis), and most importantly is simply an averaged out formula that can only tell you the relative distribution of various body masses in that population.

    4. HR Sister*

      I think biometric screenings can be beneficial. My husband never goes to the doctor, but he’ll take the time to get the quick blood draw, and at least have SOME info about his health. When I’ve done wellness programs, it’s always been an offering of biometric screenings, and if there was an incentive tied to it, you could tell us you had your annual physical in the past year on the honor system and your incentive would be the same. So I get that they aren’t meant to replace the care of a doctor, but if you are generally feeling healthy and never go to the doctor, it’s a nice option to have.

      1. oranges*

        I agree with this. I don’t have a doctor, nor to I go to the doctor regularly. My work offers an annual biometric screen and mammogram, both on site. Most years, that’s the only healthcare I receive. I’m generally healthy, but if something were to change, that’s the only place it would be flagged.

        1. Emma*

          I was going to say “what next, are they going to start doing mammograms in conference room 4?” but decided that would be unhelpful hyperbole :/

          1. seahorsesarecute*

            My company has a mamo-to-go bus come to our parking lot. It’s totally voluntary, but I’ll stick with the better quality imaging at my clinic, thanks.

            1. HR Sister*

              I’m all for whatever can help someone to get the care they might need – if it’s a mamo-to-go bus or a finger prick on your lunch break… Some people don’t know preventative care is covered at 100% (because they have bad HR?!) or they are legit scared of doctors. Also, the quality of imaging doesn’t matter one iota if your provider has age/race/weight bias. This is from someone who got a second opinion 2 years after an initial visit and had a bilateral mastectomy before 30. Healthcare is people-based, and people can make mistakes!

              1. Emma*

                I do agree that it’s good to make things available and convenient – I’ve worked in healthcare outreach doing exactly that. But you do need some separation, or to put it another way: my life plan involves never getting my tits out in conference room 4.

            2. Who Am I*

              I’ve had mammograms at the hospital and in the mobile unit and it was identical equipment and took the same amount of time. (But that may be because the mobile unit is owned and run by the hospital.)

      2. Dream Jobbed*

        My biometric screenings indicated I had the liver numbers of (according to my doctor) a large alcoholic man with cirrhosis. I was tired, but no other symptoms. And I hadn’t had a drink in six months. (About the only time I drink is on a cruise ship or other vacation where I am not driving, and still only 2 max. Just not interested in those calories.) Assuming it was fatty liver due to a bad diet, I ate right and drank apple cider vinegar. A month later went in and my bad numbers had triple.

        Couple weeks later my gall bladder was removed. No pain, so who knows how long it would have affected my other organ(s?) without me knowing if I did not have the test. So I’m pro-screening, but will only release the info on my terms.

        1. Anon for medical discussion*

          A strong genetic component is increasingly recognized for an ever-growing list of diseases and traits. On top of everything else that’s wrong in this scenario, any coaching of people towards norms on the assumption of identical outcome for identical behavior is laughably outdated and off-base.

          In the case of gall bladder, Google ABCG8 (or possibly ABCG5) or rs11887534. And…depending on your age and (lack of) dietary risk factors when this happened, maybe mention to your family that they might want to get their liver levels checked. Extreme, early onset gallbladder disease can be dramatically associated with a single gene mutation.

          If the gallstone is gigantic enough so that no part of it gets into the duct, it can be (mostly) painless for years. Mine, by the time it was removed, was ~2.7 inches in its largest dimension, more than an inch in another, and not much under an inch in the third. Which is to say, it took up practically the full volume of an average fully distended adult gall bladder.

          Basically, screening is only useful if someone’s going to believe that we are not all identical; flag the numbers that are actually potentially problematic and encourage follow up; and be on board with real intervention (including, say, days out for surgery before it becomes emergency surgery). As opposed to playing, “eat this, not that” or the “move more” shame game.

          Even when I could run on a treadmill for an hour while carrying a 50 lb backpack, my cells were glomming every bit of cholesterol (especially the “good” cholesterol, which was always too low)–from my diet, as well as whatever my body produced– and dumping it into my liver and my gall bladder to accrete into that stone.

          It’s maddening that I can present the actual genetic underpinnings of what’s going on to a good half of the medical profession, and be told that it’s somehow “negative” or “defeatist” to acknowledge the actual biochemistry of my own body, despite being able to prove to statistical significance to the biological equivalent of six sigma. I’m totally on board with you doing [that thing that works for you], or even telling me about [that thing that works for you and many other people]. Shared experience is swell. But Hell to the No, do you get to ignore me when I tell you, “This thing, in me, is actually not mechanistically related to that superficially similar thing, in you.”

          Unless work is the Mayo Clinic or equivalent, nobody at work even has the background to weigh in on this stuff, let alone the legal or moral right to do so.

          1. Zenon*

            YES! I am literally that hypothetical lady who got pregnant and ended up with permanent hypertension (thanks preeclampsia). I’ve been a runner all my life and ran and hiked right up until the day before I was induced. Prior to pregnancy my BP was on the low end of normal. It started to climb during the first trimester, hit hypertension status at 24 weeks, and the week after my crash C-section it was high enough to earn me multiple trips to the ER and a three day hospital readmission. Now I’m back to running like I did pre-pregnancy and it’s still high, though not “go directly to the ER” high. All the advice for high blood pressure is “lose weight and exercise!” and I’m like “…I already run 20-30 miles per week plus yoga plus strength training plus hiking and walking the dog and also have a baby and a full-time job and rarely eat processed food, wtf else do you want from me??” It’s clearly genetic, and it makes me wonder how many people who have equally genetic hypertension don’t get treated because they are slightly heavier than I am. It also means I would be denied HSA benefits under this system.

              2. Vimes*

                In case you wondered, 24 weeks does indeed suck. Turns out I had gained 20 lb the previous week and also apparently your blood pressure is not supposed to be 200 over something. My son was born wk 25 day 1, a small but mighty 1 lb 9 oz.

            2. Maree*

              Hi Fellow Gestational Hypertension that is supposed to go away person :-) My daughter is nearly 18 and I’ve been on meds ever since I had her (and yep – by emergency c-section).

    5. Emma*

      Right??? I read “Her company brings in a vendor to do biometric screening, which is great” and immediately thought “oh goodness, the sister’s perspective on this is going to have to be absolutely up a tree by comparison”.

      I did once work at a place which offered a similar thing to all employees. As the fat woman, I was not interested. My manager tried to convince me to take part by telling me about her friend who is a triathlete, who had the same screening and found out he had high cholesterol. She didn’t *say*, “see, this isn’t about your employer trying to find a socially acceptable way to tell you to lose weight as if it’s any of our goddamn business, promise!”, but she might as well have done.

      If I have a concern about my health, I’ll go to a doctor. If I want to increase my fitness, I’ll speak to a personal trainer. If I wanted to give up smoking (I don’t smoke), or need a sexual health screening, or anything else health-related, I know exactly where to go for professional information and advice in an appropriate context. Work is NEVER an appropriate context.

      1. Jay*

        My previous employer started this bullcrap the year *after* I was diagnosed with diabetes, started medication, and lost a significant amount of weight. So the year they started it I did not lose any weight and my blood sugar – normal on medication – did not improve and I was not eligible for the “reward.” Instead I received patronizing and insulting “counseling” EMails about my still-not-“normal”- BMI. I was *pissed.*

      2. old curmudgeon*

        Preach!

        I see my PCP every year for a physical and whatever tests are due. I also see a couple of specialists who monitor health conditions I have. And just like I don’t share my employer’s confidential data with my doctor, I do not share my own confidential health data with my employer. It goes both ways – if my employer doesn’t want me spilling the beans about private info to my physician, then they can just get the heck right out of my health data.

        The vendor my employer uses for those screenings is absolutely relentless about badgering everyone to participate. We get emails, voicemails, snailmail to our home addresses, you name it – they just DESPERATELY want to get hold of every single one of us to screen.

        The “incentive” offered is a whopping $150 payment that they don’t give you until the very end of the year – and guess what, it increases your taxable income, so your actual benefit is $150 less whatever your tax rate happens to be.

        Nope, nope, nopity-nope, NOPE. My health = my business. If my employer ever starts up crap like the OP’s sister’s employer does, I will be out the door so damned fast there’ll be skid-marks in the floor.

      3. Keymaster of Gozer*

        I’ve had an employer tell me outright that all my disabilities MUST be caused by my weight (am obese) and therefore by refusing to lose weight I was ‘actively harming myself’ which they couldn’t make accommodations for. So if I did ‘nothing’ to cure my disabilities they shouldn’t have to give me time off for them.

        Yup, ‘eat less junk food, join a weight watchers group and do more exercise’ was put on a frikkin performance review.

        2016 was a hell of a year.

        (I left. Had to. HR agreed with all this.)

        That company still exists and guess what it’s telling people who are high risk for Covid and are fat? Same. Damn. Thing.

          1. Keymaster of Gozer*

            Believe me, I tried. But – massive multinational firm versus one Keymaster…nothing happened. They’re a firm with a spectacular bad reputation…but they’re still in business.

      4. Decima Dewey*

        My health plan occasionally sends me offers to have genetic screening to find out what meds will work for me. My reaction is hell to the no. I don’t want my crappy prescription plan to have information that, say, a medication they won’t cover is what could supposedly cure what ails me–and fear they’d use the information to deny me the meds my doctors prescribe for me.

      5. Just a Cog in the Machine*

        My company gives you a reduced price on your health insurance if you take the biometric screening, but they don’t see the results. (If anyone is worried that they would anyway, you can get it from your doctor, who just signs a thing saying you had one and you turn that in.) The reasoning is that the company can make their health insurance costs lower by just having you take one (the thinking being if something is wrong, you can do something about it earlier) and then they pass that along, partially, to you. This year, they added the option of a complete physical, from your doctor, which gives you a bigger discount. There is no “pass”/”fail” just “credit/no credit,” I guess.

        I like it. Bringing someone into my work made it so I would actually get some results, rather than doing what I was doing, which was…nothing. I wasn’t sick, so I didn’t go to the doctor.

        We also have “wellness challenges,” but you can get credit by doing “healthy things” that are not exercising (drinking water, eating vegetables) or by doing minutes of activity. So, if you are a slow walker and it takes you a half hour to walk around your block, you get the same credit as someone who speed-walked a 5k in 30 minutes. And there is a variety of activities to choose from.

        I like that as well. The incentive makes me work out more days than I would otherwise. There are apparently several people in my company who lost a lot of weight (and are pleased) from the amount of exercise they did because of these challenges (and the bonus points from eating vegetables) that they then kept up with after.

        However, rewarding people for BEING in good health is bad. Some people are insanely healthy despite doing everything “wrong” and then the opposite.

    6. Reeny*

      This! Several times on biometric screenings for work I have come out as having nicotine in my system. I do not smoke and have never smoked. And when I talked to someone about it, they told me that yeah, sometimes they get false positives for it, but I could go get re-tested ON MY OWN DIME to present those results so that I wasn’t “dinged” for it. Whatever.

      1. Tidewater 4-1009*

        Do your neighbors smoke?
        If you live in an apartment and the people below you smoke, it is very likely coming up through the floor.
        If the person across the hall smokes, or the house next door with both your windows open, or people smoking outside under your windows, it could all be coming into your home.
        Signed, a person with severe allergy to tobacco smoke.

      2. JSPA*

        I scrubbed the nicotine yellow off the walls and windows for a over a week, upon moving into an old house (getting the water all over me in the process, for a few hours at a time)…and then went into withdrawal right after the removal was over, and I was no longer getting dosed through my skin. I was ready for it when it happened again, helping out a friend. No fun at all. Don’t think gloves would have helped, as it was just all over us. Again: life is more variable than the people in control of the rules imagine it to be. This is housing-based and financial-based discrimination, masquerading as health assessment.

        2. jojo*

          Sponge mop works well for scrubbing walls and windows. Then you only have to hand scrub the corners and edges.

    7. Jules the 3rd*

      Yeah, BMI’s an awful metric for height / muscle outliers. No one should be using it as a basis for health guidance.

    8. Paris Geller*

      Years of being “the fat kid” in gym class has made me dread any kind of biometric screening. It’s one thing to get labs & tests & biometrics at my primary care physician–she knows my health history and we’re working toward the same goal (a healthy me). Company biometric screenings just feel. . . dehumanizing. I hate them. My organization does offer wellness incentives (a reduction on premiums for health insurance), but I’m glad that the biometric screening is just one of many options–you can do the biometric screening, a tobacco cessation program, etc. A traditional annual exam can also count as long as you submit proof from your care provider (not the results though! Just that the annual exam happened, which is much more reasonable than this company).

    9. Cj*

      A former employer of mine had five things we were screened on. Blood pressure, if we smoked, BMI, cholestoral and one other thing. We would get $500 towards our $2,500 deductible for each one we were “OK” on. Kind of the same things as this. It is one of the largest employers in south central MN (not 3M, though).

    10. londonedit*

      Yeah, I’m a UK size 10-12 (US 4-6), I run about 100 miles a month, my legs are CHUNKY. I don’t drink excessively, I eat mainly plants (possibly a bit too much cheese but hey ho), I don’t smoke. Yet every time I go for a pill review (here in the UK you have to see a nurse at least once a year if you’re taking the pill, for a blood pressure/weight check and basic health review) it’s all ‘Ooooh well your BMI is 24, that’s getting up towards the higher range, you really do need to watch that, I really do think you ought to keep an eye on your weight, maybe do more exercise…’ Like…just ignore literally everything about the actual human being that’s sitting in front of you, why don’t you, and concentrate on one totally meaningless number. I hate it, and I’m not even having to deal with the judgement that comes when your BMI actually does nudge into the ‘overweight’ or ‘obese’ category.

  6. Cake or Death?*

    Info: what government agency would one report this company to?

    Because I definitely think they should be reported.

      1. EchoGirl*

        One thing I want to add on in case this is useful to anyone, if you (or anyone in a comparable situation) happen to be in the state of Illinois, Illinois has a statewide Disability Rights Bureau that enforces disability-related law. If an incident of this type happens in Illinois, I’d recommend reporting it to them as well. (https://ag.state.il.us/rights/disabilityrights.html)

  7. Charlotte Lucas*

    I have nothing to add, just that this is completely illegal & terrible. Also unethical & mean-spirited.

  8. PolarVortex*

    What on earth.

    I am going to hope your sister is a normal human being and is just either uneducated on how this can go wrong or so immersed in a not-great workplace that she can’t see the forest for the trees.

    If my company did this they’d get that exam over my dead body.

    1. EPLawyer*

      Maybe that’s the plan — everyone dies rather than do this — no more funding HSA’s to the max???

    2. Ches*

      Our employer requires participation in the wellness program to get a discount on the insurance. Is *that* legal? (Example: if someone has a chronic condition, you thus would have to participate in health coaching every ding dang year despite possibly having numbers as good as you can ever have due to the diagnosis.)

      1. PolarVortex*

        I’m no lawyer but my thoughts given previous experience and Alison’s above points would be yes. They’re not denying anyone equal coverage, and unless your discount is ridiculous, it falls within that range of acceptableness.

        That being said, I still hate those things, and given my 65+ year old dad just told his company they’re idiots when they tried to add in something like that to their workplace, I’m going to say that it doesn’t take a genius or someone of the younger generation to realize how dumb that sort of program is to truly penalize people who have medical conditions that won’t ever allow them to get said discount for being “healthy”.

      2. Rusty Shackelford*

        It sounds like they’re just requiring you to “try,” but to necessarily achieve anything, which is doable (as long as the wellness program is just tests and counseling, and not required exercise or anything like that) and so wouldn’t be discriminatory. Annoying as hell, sure.

      3. pitytheviolins*

        Mine does this too and I’m pretty sure it’s legal. At least for mine you can also send a doctor’s note to get the full incentive. So every year i get dinged for BMI and every year my therapist writes a letter about how the program they require to get the full discount would trigger my disordered eating and the wellness company gives me the full discount.
        It’s still incredibly stressfully and annoying!

      4. Littorally*

        Ours requires participation but doesn’t link the discount you get to the results. So — each year, fill out a survey, get weighed & measured, get your cholesterol measured and reported, and you get the discount. Doesn’t matter what the numbers are.

        Is yours doing the same, where you just have to show up? Or is it like OP’s where you actually have to get certain results?

        1. Not So NewReader*

          Then what is the point of going through all that? Sincere question. It sounds like a lot of extra steps that are not necessary.

          1. juliebulie*

            The vendor is collecting a lot of medical data. Even if they are only allowed to use it in aggregate, it is very very valuable.

            2. JSPA*

              Generally, the insurance “incentivizes” the employer. If they make 99 people miserable in ways that don’t affect their health care costs while they’re employed with the company, but also stave off just one expensive medical intervention (one less heart attack or stroke in the next year, say) that’s money in the bank for them, as well as a chance to pat themselves on the back. Whether the cumulative stress makes the other 99 people sicker some 20 years down the road, or just, y’know, miserable, isn’t included in the calculus. Plus, as juliebulie says, aggregate information has value.

          2. Charlotte Lucas*

            We have a completely voluntary option like this. You do an personal assessment, a screening (right now it’s more of a self-report because of COVID-19), & one of a choice of activities. The bio info is for you & not shared unless you want that. The focus is definitely on personal wellness goals (including stuff like stress management), & we’re given access to free online tools. No pressure, & not tied to insurance costs. If you complete all 3 activities, you get a $150 Visa card to spend as you like.

      5. Jules the 3rd*

        Yes, ‘Participation’ is legal to request. Giving you significant $$ for hitting certain targets is not. My employer used to give people $5 per test if they provided certain test results and they were ‘healthy’ (blood sugar, cholesterol), max 5 tests. I think $25 is the boundary of what’s considered ‘nominal’. You did have to submit it from the doctor. I think they also paid us $5 for dental cleanings, up to 2. They quit a couple of years ago, probably because no one’s habits changed.

          1. Quill*

            I once got an insurance reimbursement for about that much for an annual physical they told me was “covered”

            Add the two together and I can pay off <5% of that appointment!

    3. pancakes*

      “Normal” in the US often includes “has barbaric views on healthcare.” The injustices of our system didn’t fall out of the sky and land on us; we chose and continue to choose to live with them.

      1. PolarVortex*

        I mean, I’m definitely one for universal healthcare in the US but I also understand the word “Socialized Healthcare” sends some Americans to full frothy mouth state of being. Nothing is ever perfect, I just want better for us.

        1. pancakes*

          I’m not sure what perfection has to do with any of this. There are many, many, many countries that also aren’t perfect but aren’t as barbaric as this with regard to healthcare.

        2. Jim Bob*

          TBH, I really don’t want the same people that run the government to run my healthcare, for the same reason I (ideally) don’t want my employer running my healthcare. Too much power over me personally in the hands of one organization.

          1. TechWorker*

            What’s the definition of ‘run’ here though? Your employer is generally not ‘running’ the hospitals (and in countries where healthcare is government funded, the government usually isn’t either). If you really mean ‘fund’, then what are the other options? Afaict the options are: the state pays, the employer pays (not helpful if you don’t have a job!) or individuals pay. Am I missing one?

            2. Susan Calvin*

              I would add “an insurance company the individual picked from a well regulated free market pays,” which has been my experience as European (although my country errs on the side of *heavily* regulated, which has its downsides, although not the ones I’ve heard from US pundits).

            3. Jim Bob*

              Poorly worded; I do mean “funded.”

              I agree with Susan, below. Purchasing a plan from a free market would work best. What we have now isn’t a free market; it’s a combination of “confusopoly” (meaning prices are purposely hidden from the consumer) and price inflation due to employer-sponsored plans, government subsidies, and middlemen who can only thrive in an uncompetitive system.

          2. pancakes*

            There’s a 2019 study I saw an article about in JAMC that found 25% of the diabetics attending a clinic that was part of the study were rationing insulin for cost reasons. That in itself seems like a very, very high cost for a country to pay (in terms of resulting amputations, blindness, etc.), in order to satisfy your abstract and inchoate personal concerns about changing the status quo, and diabetes is far from the only health issue common in the US.

            (The article is titled, “Gathering Evidence on Insulin Rationing: Answers and Future Questions”).

            2. Not So NewReader*

              Years ago, I read where diabetics were going without food to pay for their medicines. That kind of defeats the point. My husband was diabetic and the. sheer. amount. of supplies. that he needed to be in compliance with what the doc said to do was mind-boggling.

              A friend went on a cruise with her diabetic husband. She said they really could not do much because he had to test something or take something every couple of hours. Treatments are very labor intensive and cost intensive. It’s inherent in the setup that people are going to have problems and go off-course. Set up to fail, I’d call it.

              1. Emma*

                It does vary from person to person. I have a relative who is diabetic who used to take his blood sugar once a day with a little machine, and take an insulin pill once a day, and that was it. He hates needless, so he went on a specialised diet and now he doesn’t need to do anything except have a check-up every now and then.

                On the other hand, I have a friend who is also diabetic, who has an insulin pump that she wears at all times. She still has hypos fairly often, and her two pregnancies(!) have both been really, really rough. There are lots of factors, and lots of shades in-between these two extremes too!

                1. mom of a Type I*

                  One quick clarification, there is no pill for insulin. Pills are generally to help your body use the insulin it makes (if it does – Type I diabetics don’t make their own insulin anymore). Insulin must be injected.

          3. Dasein9*

            So you’d rather have it run by people profiting from your healthcare or lack thereof?
            “You, you do get how that’s worse, right?”

            1. Jim Bob*

              A fully competitive market would be an improvement; insurers would have to compete to keep customers.

              The way our healthcare system is structured now, the price is whatever they want it to be, because you have no options.

              1. RoseMai*

                People always say that the free market will result in better healthcare prices, but there’s no way insurance companies left to their own devices would result in lower costs. We should know by now that corporations will lie, cheat, and steal for profits. At a minimum, a free market would still require massive oversight by the federal government.

                One of the main problems with just having people buy insurance, is that in reality everyone needs coverage. But if we made it easy to purchase anytime, only sick people would get it, and only when they needed it. If we make it required for everyone (so that taxpayers aren’t left with the burden of paying for emergency care for people without insurance, and so the insurance risk/premiums are spread out among those needing lots of care and those not needing any), but only available through a marketplace, then some people will not be able to afford anything, or only bottom of the barrel care with sky high prices.

                IMO, the only practical and humane option is to have a federal plan that everyone gets, and is paid via taxes (and maybe supplemental plans available for purchase or through work). Lots of other countries have shown that this is actually cheaper than what we in the US currently pay for. Plus it gives the government a huge bargaining chip to negotiate prices, and ensures that everyone can get coverage and no one has to wait until their issue becomes an emergency before seeking care.

                We’ve got to stop using “the government sucks” as a reason to not push for change. That’s all the more reason to push back and fight for better!

          4. JSPA*

            This is going into the woods…but single payer (like medicare, but for all ages) and single provider (like the UK model, but more so) are not the same thing. I have not heard anyone promote the UK model in the US.

        3. EchoGirl*

          What I think might be a workable compromise would be something like some European countries have, where there’s a single-payer type system as a default, but then if people want to purchase private insurance or employers want to offer it as a perk, that’s also allowed (as opposed to single-payer as the ONLY option). It would allow people to feel like they have freedom of choice while also providing comprehensive and easy-to-access coverage to people who can’t or don’t want to pay for private insurance. (As a side benefit, premiums for private insurance would probably go down in that system too because the companies would have to work harder to attract customers.)

          1. allathian*

            I’m in Finland, and my employer provides some basic healthcare. The reasoning behind this is that sick employees shouldn’t have to spend a lot of time waiting for an appointment. This saves money for the employer in the long run as employees get faster access to treatment.

            Paying for health insurance for our son was a good investment. When he started daycare, he had ear infections all the time and needed 4 sets of tubes in his ears over as many years. Just the cost of those was enough to cover his health insurance costs for several years, and we could get an appointment with a pediatric ear-, nose-, and throat specialist without a prior visit to the GP.

      2. Spicy Tuna*

        You are so right. I was participating in a city commission meeting on Zoom last night. One of our city commissioners has just entered remission from his cancer (YAY for him, I’m sure it’s a huge relief) and he took some time during the commission meeting to thank the doctors that provided him with excellent care and also express some kind words to many of our fellow citizens that he ran into a the state of the art cancer treatment center in our city.

        My initial reaction was “OMG, this is so tone deaf! Health care is a luxury!” I insure myself and my insurance would never pay for the cancer center he went to. I was actually about to email him to tell him he was being tone deaf and then I realized that the issue is our ridiculous health “care” system and it’s not his fault he gets good insurance. Don’t hate the player, hate the game

        1. Not So NewReader*

          OTOH, I have seen people with “good insurance” be over-medicated and over-treated. So there’s that side of the coin also.

          1. Atalanta0jess*

            Sort of, but at least we as consumers of healthcare are free to decline interventions. I’ll take the luxury of having the choice.

            1. anon here today*

              Not to get too in the weeds here, but that’s not really true. There are plenty of people who are unconscious who don’t get to decline their ambulance rides, treatment by out-of-network anesthesiologist or radiologist, and other interventions. When you’re truly incapacitated, it’s hard to set aside a few hours for internet research and then make a reasoned decision in which you say no.

              Beyond that, I had a pregnancy with certain complications that in the US warrant an automatic C-section but in Europe don’t. I wanted to attempt a vaginal birth, but there are no hospitals within 50 miles of my city that will allow it. Because I was concerned, I looked up the case law as well as the recommendations of ACOG and the ob/gyn journal articles about ethics. While ACOG guidelines do not endorse intervention against the patient’s desires, several journal articles did, and discussed the legal protections available to ob/gyns who want to perform a non-voluntary C-section. All the legal weight in this country sides with the ob/gyn performing a non-voluntary C-section; there are a number of women who have sued about this but they have all lost, because in this case you can (as a physician) argue that you felt it was in the best interests of the fetus and that automatically trumps a woman’s autonomy — I’m not trying to get political here, but that is how every legal case about this has shaken out in the US for the last 15 years. I did not want to be in a position in which I was subjected to forcible medical intervention against my will, so I found a country doctor many miles away with expertise with this complication and it all went fine (less than 7 hours in labor, healthy kid & mom). (I’m fine with C-sections overall — they are a great tool when needed. What I’m not fine with is hospital policy dictating the care I need without regard for the situation or the data, and in this case the data is extensive and contradicts hospital policy. And that ties back to the original post: arbitrary policies should not be dictating the access people have to health care.)

          2. Just Another Zebra*

            THIS. My mother had her hip replaced a couple years ago, and the treatment facility she went to tried to keep her there for weeks and weeks because of how good her insurance was. She couldn’t sign herself out, because then she’d be AMA and insurance could decline to pay for the whole surgery. It’s nightmarish.

            1. pancakes*

              I don’t agree that spending more time than desired in a treatment facility is as nightmarish as people dying in their 20s from rationing insulin.

    4. HR Sister*

      She has worked for the same company for 20 years, so I think she’s institutionalized… the company also does a waiver if you get health insurance elsewhere, and her employee has no other insurance, but chooses to go without coverage and just get a “bump” in pay. So they don’t even require proof of coverage elsewhere to get the waiver amount. I think this is one problem with staying with one company so long – you just have no idea/comparison for how things actually work. Her boss also gives her bonuses under the table, which drives me nuts and I’ve told her is absolutely not ok… but she thinks it’s fine!

      1. PolarVortex*

        Wow, that company sounds like a dumpster fire. I applaud you for trying to bring a horse to water but I suspect she’s never going to drink. Good luck!

      2. Antilles*

        If the bonuses are under the table, she’s definitely not being taxed on them.
        In order to square things with the IRS, she’d need to add that income to her annual paperwork, but I seriously doubt she’s doing that. That’s a huge issue if she (or the company) ever gets hit with an IRS audit.

        1. HR Sister*

          Preaching to the choir! Not to pile on her employer, but they were also allowing work travel over the past year, which really bothered me as well. I wonder if long-haul COVID would disqualify employees from the HSA funding!

  9. Nanani*

    Six months to say, drastically change your weight would likely cause more harm than good.
    Not to mention, we’re still in a pandemic? And have been for nearly a year?
    “You have 6 months to start an exercise routine but all the gyms/pools/arenas are closed”
    (and the ones that are open are probably a bad idea to visit)

    1. EPLawyer*

      How does one fix sickle cell anemia or leukemia in 6 months? Or macular eye degeneration.

      Bssically the people who most need an HSA will be hurt by this.

      I would NOT want HR knowing my health details unless I need an accomodation. Soooooo much grounds for this to be misused.

      1. TX Lizard*

        This absolutely penalizes those who most need an HSA, and will make it even harder for those people to get care!

        1. Cat Tree*

          Yeah, I have several chronic conditions that are mostly under control, or are treated to the extent of being a nuisance rather than debilitating. But it’s a lot of doctor appointments just to monitor and manage all these things. I usually think about it positively because treatments are available so I can have an almost normal quality of life, and I make enough that I can afford the doctor visit co-pays and medications. But I really make heavy use of my HSA!

          Making treatment affordable is how you help people get and stay healthy. My company has a special program for diabetes (one of the few things I don’t have), and all medications are fully covered with no expense to the employee. It’s cheaper for the company to cover this cost so people can stay healthy, rather than pay to treat the complications if someone can’t afford to optimize their treatment. (It’s also just the right thing to do.)

      2. many bells down*

        I’ve got a congenital heart defect. Yeah, it can be “fixed” but any fix is temporary. I got a replacement valve 2 years ago… that might hold me for 8 more years, assuming nothing else comes up.

        Also my thyroid isn’t magically going to grow back (and if it did that would be BAD considering it was cancerous)

      3. Artemesia*

        /but once we know you have any of these things we can put you on our list for no promotions and the next layoff. Oh and get you an annoying health coach who will call and hound you from some phone bank in India.

      4. Anomalous*

        Yeah, I would sure like to fix my Type 1 diabetes. The cure has been 5 – 10 years away since 1990.

      5. Quill*

        In 6 months I suppose I could “fix” my messed up feet by getting new orthodics? Everything else I’m assuming they just want everyone to diet.

    2. Observer*

      Six months to say, drastically change your weight would likely cause more harm than good.

      It may not even be POSSIBLE. There are many reasons for this, but it’s true.

      There are actually very few conditions that you can actually “fix” in 6 months.

      1. Bear Shark*

        Shoot, appointments for some of my medical conditions have to be scheduled 6 months in advance. If I could fix them on my own in only 6 months I already would have.

      2. Littorally*

        I mean, there’s possible and there’s possible.

        I always tell people who focus on weight above all else, great, do you recommend the cocaine or the meth diet for weight loss? Cause that’s the only way it’s going that fast.

        1. Not So NewReader*

          When I switched to just eating whole foods, I lost 3 sizes …. and a massive 4 pounds. You could visually see the difference but the scale did not budge that much.

    3. Nea*

      I… I can’t even. I just cannot, there is no even. Let me unpack this suitcase from hell:

      1) How is someone supposed to “fix” a disability, congenital problem, or inherited condition in ANY time period?

      2) Six months to lose weight – and everything else tends to be blamed on weight, doesn’t it, especially a woman’s weight – can do horrible things to a person’s health. If you try fast weight loss by diet and exercise, you mess up your joints, metabolism, and (based on watching someone do this) gall bladder. If you try it by liposuction or surgery, you’re adding surgical complications to formerly healthy internal organs. And that STILL won’t fix so many things that Are. Not. Weight. Related.

      3) What happens to someone who has an accident or is otherwise injured? How are they supposed to “fix” that?

      4) Recovery times for certain routine surgeries START at 6 months. Some can take over a year for full recovery.

      This is absolutely unspeakable and I’m staggered they haven’t had a lawyer telling them to stop discriminating.

      2. No Gallbladder Anymore*

        I had to have my gallbladder removed due to severe gallstones; I have a high propensity for them apparently and I’m not supposed to try to calorie restrict or eat a lot of high-fat foods because of it. On a related note, I’ve also had disordered eating issues in the past that could also be exasperated by calorie restriction or weight loss attempts. Am I supposed to just grow my freaking gallbladder back???

        1. Nea*

          I know one person, one person who really did the “I’m going to lose a lot of weight and get fit in 6 months no matter what I have to do.”

          What she had to do was eat nothing (and be angry and tired all the time because of it), exercise intensively every single night (and be exhausted, aching every day, and also put every other project or plan on hold, like classes and hobbies), and what happened to her gall bladder is terrifying. Suffice it to say that after many agonizing attacks, she did lose the weight of one (1) gallbladder.

          I have no idea if in the long run she felt all that was worth it or if she kept the weight off/muscle on. All *I* learned is that it wasn’t worth it even if I could physically do it.

          1. No Gallbladder Anymore*

            My condolences for your friend’s issues; gallstones suck, starving yourself to that extreme really sucks, and nobody deserves to feel they’re trying their hardest and doing their best only to wind up hospitalized and needing surgery. My history isn’t quite the same as hers, but it wasn’t much better either; I hope stories like hers and mine are rare, that’s for sure.

      3. Autistic AF*

        I’m particularly frustrated because many of my health issues are caused by my workplace. I’ve been denied even investigation into basic, no-cost accommodations like headphones and then told I couldn’t take sick leave for the constant anxiety attacks that resulted.

      4. Not So NewReader*

        When we are little kids, we believe that doctors magically fix everything in short order.
        At some point we become adults and realize this is not what actually happens.

        I am seeing a bunch of 5 year olds with magical thinking.

        1. Julia*

          Right? I wish I could go see any doctor and just be like, I have this issue, fix it! Most don’t even listen. That is, if you can get an appointment in under 3 months…

      5. ceiswyn*

        I had 17 stone to lose. It took me 2 1/2 years, and THAT was actually unhealthily fast. 6 months? The laws of physics say no before you even start on whether it’s a good idea.

        1lb is approximately equal to 2500 calories. I’m sure you can all do the maths.

        1. Just Another Zebra*

          Most weight loss apps/ programs/ etc recommend 1lb/ week for weight loss. If you have to lose 50lbs… that’s a year, if you stick to whatever regime you commit to PERFECTLY. Spoiler alert – no one does (because pizza and birthday cake are delicious). Asking people to “fix” their weight in 6 months is so deeply unhealthy.

          1. ceiswyn*

            Also, I typoed; 1lb a week is 3500 kcal, not 2500.

            In order to lose 1lb per week, you need to be undereating by 500 kcal every day. In order to lose more than that, you need to create a bigger deficit. Most women require about 2,000 kcal per day to run their body, and there’s a limited amount you can drop from that and still take in essential nutrition.

            Also, and here’s the important thing, your body can only burn fat so fast, no matter how much you undereat. If you starve yourself for weeks you won’t lose fat much faster; what will happen is that your body burns muscle (note: your heart is made of muscle) and essential aspects of metabolism stop functioning properly due to lack of fuel.

            In short, THIS IS A TERRIBLE IDEA WHY DO INSTITUTIONS AND MEDICAL PERSONNEL KEEP ENCOURAGING IT?!?!

  11. Snarkus Aurelius*

    The reason the American health care system is so horrific and inefficient is because of *systematic* problems, like tying health care outcomes to profit instead of, you know, not dying.

    *Individual* changes will not make us healthier or less likely to need care. Sure, you can eat healthy or exercise more, but you’ll need a decent paycheck and the luxury of time and a car to do that! Also you can be the healthiest person on your employer plan, but it doesn’t mean anything if you’re the only one.

    This approach isn’t as bad as the Whole Foods CEO’s plan to reform health care though.

    1. Crivens!*

      Before everyone jumps all over you for pointing out broken our health care system is: I appreciate knowing other people see how broken it is. Thank you for pointing it out.

    2. Batgirl*

      I promise I’m not being the smug European by asking*… But has the past year at all dented the idea that jobs and healthcare are good partners? Because pandemic can mean job loss + sickness at the same time? I just think we all need our ideas shaking up about looking down on who gets sick and why. *In the UK I’m hoping this year will protect how well the government funds the NHS going forward.

      1. Not So NewReader*

        I think the disconnect remains and in some cases the disconnect is even worse. That is because companies are too focused on the bottom-line and not employee focused.

      2. ThatGirl*

        Well, part of the goal of the Affordable Care Act, which was passed in 2010, was to offer affordable health insurance on the open market to people regardless of their employment status. Prior to that you could, theoretically, buy your own insurance but it was often super expensive and you could be locked out for having a “preexisting condition”.

        Now, the ACA has not been universally successful at this but it has improved things in that regard. But yes, I think that the pandemic has further driven that home.

      3. Charlotte Lucas*

        The crisis has caused some people to finally notice that rural America has been undergoing a massive healthcare crisis for years now, as more clinics & rural hospitals were “run as businesses” & focused on profits, then eventually closed. Many people have to drive for a couple hours to see a provider other than a GP, if that.

      4. Not A Manager*

        “Has the past year at all dented the idea that jobs and healthcare are good partners?”

        No.

      5. TeapotNinja*

        That depends on who you ask.

        You ask regular, not rich people and the answer would be a statistically significant change towards yes.

        You ask right-of-center legislators, which in the US includes all Republicans and the entire leadership of the Democratic party, and the answer would be the opposite. They’re fully captured by the insurance and healthcare industries.

  12. LadyByTheLake*

    Not only is this abelist, it is likely ageist as well. As those of us who have gotten older can attest, we are no longer the spry, svelte, utterly healthy people we once were. Ah, for the days when I could decide to lose ten pounds and then through moderate diet and exercise, just do it! This program seems purpose-designed to discriminate against older workers, just because they are older.

    1. LadyByTheLake*

      I hope it is understood that the “pry, svelte, utterly healthy people” is tongue in cheek.

      1. Guacamole Bob*

        Wasn’t there a letter here a while back where someone who was pregnant got dinged for a high BMI on a wellness screening and told she had to do some sort of health coaching? Or maybe it was a commenter. But

      2. Cat Tree*

        If you can time it just right, with the first weigh-in at 8 months pregnant and the check at 5 months post-partum, I guess that would count as fixing it?

    3. Observer*

      This program seems purpose-designed to discriminate against older workers, just because they are older.

      I doubt it. Because there is SOOOO much that is flat out ignorant here that I doubt that they are able to be that targeted.

      If the argument that OP’s sister is making is even close to what her company thinks, then they have LESS than zero understanding of how health works. Aha! If you couldn’t “fix” your problem is 6 months, that PROVES “you weren’t even trying!”

      People have brought up the issue of weight loss, and some permanent types of conditions. If anyone wanted to make a full list, that would take up the entire screen, AT LEAST. And there is more! It can take time – YEARS to actually get a diagnosis. Not that a diagnosis means you will be able to “fix” your problem. But without one, you DEFINITELY won’t be able to.

      The bottom line is that there will almost certainly be disparate impact, but I think are too stupid, to actually effectively target a specific group.

      1. Empress Matilda*

        Oh yes, they “weren’t even trying.” Because unhealthy people just need to TRY harder to be healthy, that’s all! Grrrr.

        OP’s sister’s employer’s ludicrous health care scheme can die in a flaming inferno of hell, as far as I’m concerned.

    4. meyer lemon*

      I think the days when I could intentionally lose weight ended in my teens, based on the fact that I’ve been the same weight for several years regardless of eating and exercise habits. I don’t really gain weight either–I guess this is just my weight now.

      1. TechWorker*

        Tbf this was me too until I stopped leaving the house last year… now slowly losing that weight :p

  13. ThatGirl*

    Jiminy Christmas.

    I worked for a company for 9 years that instituted something … KINDA similar, but not nearly as horrible, ableist or illegal. It was basically incentives for a) taking part in a biometric screening b) if you didn’t meet certain criteria (BP, cholesterol, BMI, glucose levels, smoking/nonsmoking) you had to do various wellness activities designed to try improve these things to get the full incentive amount. But it was things like… meet with a wellness coach, walk 4 times a week, meditate, quit smoking … still kinda icky but even if you never lost any weight or lowered your cholesterol you could still get the incentive by participating. And that was money off your monthly premium, not funding an HSA.

    1. SnowWhiteClaw*

      Requiring people to walk or meditate in exchange for discounts is ableist. Not as ableist as the OPs company though!

      1. PT*

        Meditation can be a violation of religious rights. Some religions view meditation as an inherently prayerful act that cannot be secularized.

        1. pancakes*

          Which religions? I took part in a study abroad program in India and Nepal on comparative meditation traditions and this is new news to me, but I don’t know much about western religions.

          1. Sara without an H*

            Some of the stricter Protestant Christian denominations are against it. They see meditation as inextricably linked to Eastern religions.

            1. pancakes*

              That’s pretty wild because the links people supplied below and the apps talked about in them didn’t leave me with a handle on which particular eastern religions they see it as linked to! Very little of what’s marketed as meditation in the west even bothers to talk about, for example, the differences between Mahāyāna and Theravada Buddhism, on even a surface level. I think some of the Rinpoches I studied with would’ve have a good laugh at the idea that meditation branded genetically as a relaxation technique, with no talk of bodhisattvas or the five precepts or etc., is too religious.

            2. JustaTech*

              This might be super ignorant of me, but could a person who’s religion forbids “meditation” be allowed to exchange it with “prayer”, since they’re seeing them as similar, on some level?

              Like, “peaceful contemplation”?
              (The first time I ever did a meditation thing was at my Episcopal church as a kid. I’m not religious now.)

          2. Not So NewReader*

            I grew up Catholic and they definitely did not like that meditating stuff at that time. “Free-thinking” was condemned, as thinking on your own could be an entry point for the devil. By extension, meditation might accidently cause the devil to slip into one’s mind.

            Then we’d get scolded for not thinking on our own…. so… yeah… Personally, I just pushed to get through the 8 years and get OUT.

            1. turquoisecow*

              As part of my Catholic upbringing I actually had a class with meditation. It involved visualizing letting go of the world around you and meeting with Jesus or something along those lines. It was part of my education in preparing for confirmation.

      2. ThatGirl*

        Those weren’t the only things you could do, just some options — but I don’t disagree with you, that’s why I said not *nearly* as ableist.

    2. TiffIf*

      My company had wellness checks that if you participated in them, you got a 80/20 split on how much of the health care premium the company paid, instead of a 75/25 split. Literally all you had to do was the wellness check. The insurance company then encouraged you to participate in other wellness activities like the ones you mentioned but the company didn’t know and didn’t care.

      A few years ago they eliminated the wellness check entirely and just made the 80/20 split conditional on if you had your yearly physical (which, under the ACA has no copay) and they even gave you up to 2 hours of paid work time to do it in.
      The company didn’t know anything about the appointment other than it happened. It was for a few years just a form the doctor signed saying “This person had a physical”. Then it went straight to just a self-reported checkbox.

      Last year they suspended even that because of the pandemic. They might re-institute it after the pandemic? No idea.

      1. JustaTech*

        See, *that’s* a sensible way to encourage people to do a health check. Privately, with your doctor, without reporting the results to the company.
        And the two hours off is really nice too.

    3. PollyQ*

      For all that people rave about meditation, there’s a good chunk of the population for whom it’s actually harmful. Yet another example of how employers or even insurers shouldn’t be making broad requirements for people’s health care choices.

      1. Burnout Phoenix*

        I’d love to have a link to a reference on meditation being harmful. (I have enough friends who say it puts them in a bad mental state — so I’m asking not because I don’t believe you, but because I DO believe you).

        1. Anonymouse*

          Not directly on meditation but an anecdote about one of those kind of anodyne “helps everyone” things.

          Gratitude journals–there are so many people who love them and who are helped by them during rough times or depressive episodes. I am thrilled for them that it works so well.

          For me however? I just can’t. I have tried, but when I am having a depressive episode documenting all the things I have and am grateful for sends me into a mental spiral of “see, you have so much you don’t deserve to feel depressed”, “You shouldn’t feel this way, there are so many people who don’t have all this” which then makes me feel even more depressed.

          When my brain is not in depression mode, its great, I get benefit from it, but if I am in depression mode—makes it all worse.

          1. Guacamole Bob*

            I know someone with depression who has found at times that depression makes her suicidal. Every new health care provider who finds out she has depression tries to tell her she should exercise more, because it’s true that it works well for a lot of people. But that doesn’t mean it works for everyone!

            1. Guacamole Bob*

              Err.. I mistyped. She has found that exercise makes her suicidal. Depression, too, some of the time, but that wasn’t the point of my comment.

              1. allathian*

                Ouch… Exercise making someone suicidal, that must be tough.

                I can feel pretty good after exercise, but during it, absolutely not. The only exception is tai chi, I can feel good doing that when I hit the zone. But any kind of cardio or muscular exercise makes me feel like I want to die if I strain myself hard enough. But wanting to die isn’t the same as being suicidal, and the feeling passes as soon as I stop exercising so hard. But it does mean that my exercise isn’t as effective as it might otherwise be, because it’s so hard for me to push myself out of my physical comfort zone.

          2. lazuli*

            Yes, when I worked as a therapist, I stopped recommending them across the board for this very reason. It really seemed like it helped about half the people and made the other half feel worse. I would sometimes offer it as an option, but always with an explanation that if it was making things worse then the client should (a) STOP IMMEDIATELY and (b) know it was a common reaction, not a personal failing.

          3. office peon*

            wow, i am so relieved to read someone else has this same reaction! Thank you for this post. This is one of those “i thought it was just me/there must be something wrong with me” things….

          1. Emma*

            Just for clarity, mindfulness is the fashionable type of meditation (which I haven’t tried but sounds godawful!). There are also other types of meditation which are very different, and also may or may not be helpful for any given person.

            1. JustaTech*

              I like mindfulness, but even my psychologist who suggested it was clear that 1) it’s not a cure all, and 2) to only do it if it felt helpful.

              For me, I find it helpful, but only helpful. It’s like the orthotics in my shoes – they help my knees, but I still need to do my stretches and not do some kinds of exercise.

          2. Littorally*

            Oh man, that article describes so much of what I’ve experienced when I’ve tried mindfulness. All my muscles immediately lock up and I’m in hideous pain within ten or fifteen seconds.

          3. Not So NewReader*

            Excellent article, thanks for the link.

            I found this paragraph to be absolutely priceless because it’s value is so high:

            “Rather than removing the source of stress, whether that’s unfeasible workloads, poor management or low morale, some employers encourage their staff to meditate: a quick fix that’s much cheaper, at least in the short term. After all, it’s harder to complain that you’re under too much stress at work if your employer points out that they’ve offered you relaxation classes: the blame then falls on the individual.”

            Bingo, bingo,bingo.

            Companies are doing everything they can think of to blame the victim.

        3. TechWorker*

          Link in moderation.. I have not experienced really bad side effects or anything but I do not enjoy meditation at all, it makes me feel stressed out and twitchy.

          1. pancakes*

            I want to point out that this article is about about a particular meditation app. There are many, many types of meditation, and they aren’t all marketed as relaxation techniques.

        5. zaracat*

          I’ve posted one link below, but there is quite a lot of info out there on different types of meditation related problems – try searching on “meditation + trauma”, “meditation + psychosis”, “meditation + suicidality”, “dark night of the soul”. One common thread seems to be that reaching a deep state of meditation drops the psychological defences that are protecting you from being overwhelmed by distressing mental content. My own experience was of meditation being great at first, but as I did more it became problematic, culminating in a one day silent retreat causing unstoppable crying, 24 hrs of stress related vomiting and having to take two days off work.

          https://www.goodtherapy.org/blog/mindfulness-meditation-and-trauma-proceed-with-caution-1021154

  14. nnn*

    Also, not all “issues” can be “fixed”!

    Also, not all issues that can be fixed can be fixed within an arbitrary timeframe of six months!

    Also, not “fixed” ≠ “not even trying”! It is possible to make a diligent effort and still not succeed – especially when the goal and the deadline are arbitrary!

    1. Lacey*

      Yes! That’s such a weird way to look at it. I have a chronic health condition. I can manage it more or less effectively, but it doesn’t go away.

      1. Seal*

        Same here! Given the nature of my condition – which I acquired 5 years or so ago through no fault of my own – I would LOVE to be able to “fix” it in 6 months. Since that’s not possible I’m happy that my chronic condition can be managed effectively through the miracle of modern medicine.

        1. TiffIf*

          I would love to be able to “fix” the condition I was born with that has necessitated life long relationships with the medical profession. Just tell me when you can regrown and attach nerves that have never connected to my brain and teach my brain how to properly respond to and control them, regrow a major organ that was removed because it couldn’t function properly, create an organ and muscles and attach and make them able to respond to my brain’s signals that I was born without, enlarge an organ that never grew to a proper size…

          1. Empress Matilda*

            Come on, TiffIf. You’re barely even trying here! Get with the program, will you?

            (This was sarcasm, in case it isn’t obvious. S0unds like you have a lot to deal with – and my guess is you’re already dealing with it as well as you can!)

          2. Not So NewReader*

            And this is where the wheels fall off in our system.

            In a setting like yours TiffIF, we (society/medicine) should be looking at figuring what things are actually working for you and how to support those things. We are well practiced at listing off everything that is wrong.

            There is much to be learned from watching what is going right.

            I am sorry life has been so cruel and unjust for you.

    2. Anon Anon*

      That was my immediate thought when I saw this! Aside from a host of disabilities, what about chronic illnesses?

      I’m a Type 1 Diabetic; guess if I’m not downing cinnamon all the time and eating no carbs I’m not “trying hard enough.” Yeesh.

      1. Anomalous*

        Yeah, you could undoubtedly regrow those beta cells if you just TRIED HARDER.

        (Another Type 1 here…)

      2. Observer*

        Well! If you just ate RIGHT you could absolutely lose our dependence on insulin. No doubt about it! Your just not trying!

        A shocking number of people actually believe that. It’s scary. It sounds like the OP’s sister might be among them.

    3. Allie*

      My former boss died of cancer a few years ago. She had been sick for a few years (people can be sick with cancer but stable for a while and then suddenly get worse). The idea of her being cut off from a benefit because of that would be shocking.

      1. pancakes*

        I had cancer around 10 years ago and it has never stopped shocking me how open people who support this sort of thing are about it. People who look & otherwise act perfectly normal and have perfectly normal educations and careers and families may or may not believe those of us who develop serious illnesses like cancer should basically just drop dead, the sooner the better. And the people who do believe this don’t think of themselves as being diminished by it at all, let alone barbaric. The idea that someone, somewhere will save a bit of money by way of their own barbarism is enough to satisfy them of its propriety.

      1. Analysis Paralysis*

        Hard agree on all 3 counts!

        OP’s sister’s reaction to this also reminds me of other posts here where people’s idea of “normal” or “reasonable” got really skewed by a toxic environment. If the company culture has a closed minded and ableist outlook on employee health, people who work there are pretty likely to absorb some of that.

        1. pancakes*

          I think this is getting overstated. Not many people arrive into the workforce as a blank slate politically, with no views on healthcare and no tendency to moralize health (or not) until shaped by their employer.

          1. Batgirl*

            True, but I think trying to parse out which influences come from the employer and which come from *somewhere else* is taking unanswerable speculation to a whole new level.

            1. pancakes*

              There’s not much parsing required to acknowledge that most people’s views on healthcare aren’t shaped solely by their employer.

      2. Batgirl*

        It’s a little bit like when companies veer into fields like psychology and mental health with a “we’re just halping” attitude. Because they have no earthly idea what they’re doing they can’t help but be offensive and harmful.

    5. CatMintCat*

      I have had Type 1 diabetes for over 50 years. I don’t think 6 months of anything is going to do much for that.

  15. Lacey*

    Well that sounds just awful. My last employer had some kind of incentive where you get two free yearly preventative appointments. You got to choose what and they didn’t get the results.

    I think my current employer does a small HSA bump. Like normally they just match the contribution up to a certain dollar amount, but if you do the screening you get an extra $100. I’m not on the insurance, so I don’t recall the details.
    There are also smaller incentives too. Like if you get your flu shot (which is free) there’s a bump. If you join a gym there’s a bump.

    1. pbnj*

      I worked somewhere that did something similar. It achieves the goal of encouraging employees to take preventative health measures and help employees to potentially catch a health issue early. I know many people won’t make the time to get a checkup, but if you give them $100, they’ll go.

      1. Middle Aged Lady*

        THIS! My spouse only agreed to therapy because the first six appts were free with our EAP.
        Anyway, Medicare for all.

  16. AnotherLibrarian*

    Wow, I can’t even… I’m neither a lawyer, nor an HR person, but I can think of so many ways this could lead to a lawsuit. It’s disturbingly both quite fatphobic and ableism heavy to assume that people’s health is really under their control and that “trying” is something everyone should strive for. So much badness here.

  17. Allie*

    Yes, this is illegal, shocking, and unethical.

    Childbirth is super expensive, too. What are they thinking?

  18. Bob*

    The worst part is that they are likely so emotionally invested in the awesomeness of their “genius” plan that if anyone tries to say anything or do something about it all hell will break loose.
    That is not to say this does not need to be fixed yesterday. Prepare for fireworks.

  19. Emi*

    Besides which, this is totally pointless because it’s not like they get the HSA funding back if you don’t spend it, yeah?

      1. PollyQ*

        That’s not correct. Once money’s been put in an employee’s HSA account, it’s theirs to keep. If sister’s company is hanging on to that money, then it’s yet another way they’re breaking the law.

      2. Firecat*

        So like Emi said the employer won’t be getting the funds back if the employee doesn’t spend it.

        However as an aside employers can clawback unspent HSA funds. Not sure of the rules involved in that but I know my prior company did.

        1. HR Sister*

          That’s interesting… The only reason I’ve seen allowable for that is if a deposit was made in error. It’s a bank account, with employee ownership. We had an admin duplicate a payroll’s deposits, and had to fill out a form for the amount, reasoning, etc. that we were pulling back. They have really in-depth regulations for these accounts.

          1. WellRed*

            That’s the only thing I’m aware of. How would an employer know if an HSA had unspent funds? And if the employee is putting money in it the employer can’t claw back the employee’s money.

        2. Jaydee*

          You might be thinking of an HRA – health reimbursement account. OldJob switched from a plan where they made generous HSA contributions to one where they made generous HRA contributions for precisely that reason. The money was there if the employees needed it, but any unused funds reverted back to the employer.

  20. Alex*

    If I was interviewing at a company and found out about this practice I would most likely not take the job. This is horrific.

  21. TiffIf*

    What if someone of a certain ethnic group has a genetic condition that they are under physician’s care for, but can’t completely alleviate?

    This is practically ANYONE with ANY pre-existing condition.

    I was born with a number of issues for which there is no cure or fix, just surgery (lots and lots when I was young) and maintenance which means lifelong medical costs that no amount of diet and exercise or yoga and wellness coaching will ever be able to change.

    I also struggle with my weight. A few years ago I made some diet changes and managed to lose a significant amount of weight. My knees hurt less, but other than that my medical needs have changed not one iota–because they were not caused by my weight nor even exacerbated by my weight.

    1. Momma Bear*

      For some conditions, the treatment causes weight gain. I could see this company’s number crunchers deciding that someone gaining weight was bad, even if it improved another condition.

      1. Seal*

        When my now-chronic condition first manifested itself, I had to go on large amounts of steroids for months. The side effects included being cranky and hungry all the time, so I gained a significant amount of weight in short period of time. I wasn’t happy with the weight gain but felt it was a small price to pay to get my vision-threatening condition under control.

      2. Keymaster of Gozer*

        Some of my medications do exactly that. I could eat half the recommended calorie input for an adult woman and still be fat. My body is messed up, yes, but the weight is a consequence of them, not a cause.

  22. TX Lizard*

    My jaw dropped reading this. I have an autoimmune condition that is under control now, but may cause more health issues as I age. Would love to fix that in six months! Is the company funding whatever “fixes” they are hoping for? Cause I’ve heard that Crispr might someday fix my condition, if someone else will foot the bill.
    I can’t even really think of any health issues that can be permanently fixed in 6 months, other than like, an ear infection. Ridiculous.

    1. RinaL*

      My daughter is in the same boat. Genetic problem, orphan disease, only fixable by CrispR and in the meantime pills to circumvent more drastic problems like multiple organ failure..

      Lets hope that it will be someday just like a flu shot – at the moment its 1Mio/Patient where I live and restricted to the worst diseases where pills are not an option..

    2. LemonLyman*

      Same! At the age of 30 I got very sick. I have an autoimmune disorder that seemingly came out of nowhere. I now take some very heavy hitting meds that have had some serious side effects that also impede my health. But it’s better than death. This is all outside of my control and, trust me, I (and my doctors) would LOVE to fix it if it were possible.

      OP’s sister works at a horrible and very ableist place.

  23. MI Dawn*

    My employer (related to health) pre-covid – did – annual health screening clinics. An outside company came in, they did height, weight, BMI, fingerstick glucose and cholesterol. Generally you could also get a flu shot at this clinic. Employer did not get any results, except, perhaps, in the aggregate – you walked away with the little sheet they wrote them on and nothing was ever written down anywhere else. You had the option to attend the clinic or submit a from from your private care giver that you had an annual exam (no details required except date and that the MD did the same tests – check boxes yes/no on the sheet).

    No real perks from opting in (except flu shot on site!) and no penalty for opting out. On the other hand, there are penalties on other parts of the program (extra charges for smokers who don’t attempt to quit, people who don’t attain certain levels of the program.) There are other ways to attain the levels for anyone with health issues who can’t exercise, and they are not penalized unless they don’t do the alternates offered or submit a note from their MD that they are not capable of doing any of the alternatives (I had one employee with serious, chronic health issues who was not capable of doing any of the choices. They were very easily opted out with no penalty as long as they did the no smoking part. And the opt out did not require annual renewal.

    1. Midwest writer*

      I worked for a company that did these for a few years. I did the one at work one year and one screener chastised me for my weight (I was a mid-20s woman who was wearing size 8 jeans … not stick skinny but not overweight based on my height). She was a big chagrined, however, when my BP and cholesterol numbers came back in the range of a very healthy teenager. I was incredibly active at the time, ate a mostly vegetarian diet and was in really good shape. It was such a weird experience.

      1. HR Sister*

        This is kind of funny, because the whole reason my sister brought this up is that she’s vegetarian, so her bad cholesterol was low, and her good cholesterol was high… but her HR dept actually averages them (what?!), so overall they told her she has high cholesterol and has to “fix” it to get her funding. Yup.

        2. Artemesia*

          So stupid — her numbers are excellent. And it is another example of turning loose people with minimal expertise in the area to make these judgments. She would harm her health by complying. The ‘they’ who told her that is probably some minimally trained functionary with a list of rules to follow who knows little about health. This is one to push back on but the whole program needs to be opposed.

        3. EPLawyer*

          aaaannndddd your sister is still okay with this program?

          Your sister has allowed a toxic workplace to warp her norms.

          1. HR Sister*

            Yep! She has been there 2 decades and like other articles on AAM – you just don’t see it when you’re in the thick of it.

          2. pancakes*

            I think this is bigger than workplace norms, though. This is the heart of many Americans’ politics – they would rather lose or not have access to a benefit themselves than share it with someone they regard as undeserving (“She thinks that they shouldn’t reward people who aren’t even trying…”). It would probably take more than a new job to shift this mindset. It’s also a very common mindset, and there’s no guarantee a new job would be an opportunity to break away from it, even if she wanted to break from it.

        4. Lisa B*

          *boggle* They “averaged” the cholesterol numbers??? And this didn’t throw a hundred flags up for your sister??

          1. HR Sister*

            It did not. I don’t think she’s had cholesterol issues or anything, so it’s probably not something she’s discussed with her doctor. Not everyone has the same knowledge base, so I imagine things like this are how the company gets away with what they’re doing??

        6. Batgirl*

          Is there a provision for her doctor to overrule this or is it a “the computer says no” type of situation?

        9. Not So NewReader*

          “Dear HR,
          You have informed me that because my good cholesterol is high and my bad cholesterol is low, that I have an average of high cholesterol. It looks like this means you think I should raise my bad cholesterolm so my average would be lower. Please verify in writing for me.”

          Signed
          Your soon to be Ex-employee.

        10. Observer*

          So your sister is OK with *HR*, HR! making medical decisions for people, thinks it’s reasonable for people to penalized for actually BEING HEALTHY, and ALSO thinks that someone who won’t take this TERRIBLE advice is “just nor trying”?!

          Yeah, she’s got her norms warped. What did her doctor say about the cholesterol?

      1. HR Sister*

        Most vendors that market these programs to companies will tell employers that they can provide aggregate data, but not individual… I don’t know if employees have to do a waiver to release the info to their company. I would certainly hope so, otherwise, I think the vendor is on sketchy ground.

    3. Mimi Me*

      my company offers money towards the HSA for things like “Have a physical”, “get your flu shot” or “Have your Mammogram”. Things most people would do in the course of a year. If you do them sooner rather than later that money is in your HSA for the other stuff during the year. And the bulk of the things on the list are all under our preventative care benefit so would be covered at 100%. That’s how these programs should work.

  25. KaciHall*

    My last job did a smaller version of this. You got a heavily discounted insurance premium if your BMI was ‘healthy’ (actually just under a certain number), or if you’d lost 10% of your weight from the previous year (or start date). So since I was eligible at the end of November for insurance, I would’ve had to lose 20 pounds by January 1 to qualify for the half price insurance.

    I told the HR people that it seemed like a very dangerous practice to not have it tied to a prorated version, but she just laughed and said ‘we didn’t think you’d be able to do it! ‘ Always lovely to know multiple HR people are discussing your weight!

    1. Nea*

      It’s always weight, isn’t it? They always obsess about weight, regardless of whether it has anything to do with your condition, regardless of how dangerous and unhealthy it is to try to shed a lot of weight fast (like 20 pounds in 4 weeks!)

    3. HR Sister*

      These are the people that give HR a bad rap. That’s so awful. I’m sorry on behalf of my profession!

    4. Ryn*

      Talk about an extremely fast way to trigger an eating disorder relapse and end up with someone in the hospital.

    5. Not So NewReader*

      Always nice to know when your company feels you are set up to fail and thinks that is very funny.

  27. Precious Wentletrap*

    “We’re sorry, Pnurtis, your numbers are bad, you have six months to stop being an amputee.”

  28. Momma Bear*

    So an HSA is a Health Savings Account, not an HMO or PPO healthcare insurance plan. What if, for starters, an HSA is a bad idea for you/your family? Is that the only health insurance option at that company?

    https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/health-savings-accounts/art-20044058

    I think this is horrible for already stated reasons. I hope your sister gets out of that company OP. No one evaluates my health aside from me and my chosen physician.

    1. HR Sister*

      An HSA is an account you can put money in (or your employer) pre-tax to pay for certain covered expenses… you have to be covered by an HDHP plan to be able to contribute to the account. So they are covered by a plan, the deductible is just higher than the other plan basically, it has to meet a minimum amount. I’m not sure if they offer another plan and then seed an FSA in a like manner… they might.

      1. Librarian1*

        Right, but HDHP plans aren’t the right choice for everybody. Some people save more money with an HMO or PPO.

        1. Snailing*

          Well, an HDHP can be a PPO or an HMO. The latter two are network types, whereas the HDHP designation deals with the deductible and if it’s high enough to qualify for an HSA. The IRS minimum HDHP deductible right now is $1500 (individual). So it’s not really an apples-to-apples comparison.

          Though I absolutely side-eye companies that have an HSA qualified plan set up to get lower premiums but then don’t do any employer contributions.

    2. Atalanta0jess*

      It’s not at all uncommon for HDHPs to be the only insurance option offered by a company. I’m kind of boggling at this comment, because yes, insurance plans are not one size fits all, but I thought it was pretty typical to get what you get. One of the many problems with employer sponsored healthcare.

      I have been lucky to work at places with great benefits, but the best I’ve ever gotten was two choices.

  29. MistOrMister*

    Oh this would make me so mad!!! Sure, some people eat and drink crap all day and never exercise and are in horrible health, but some do the same thing ajd their numbers are all fine. Meanwhile you can have someone who eats healthily and exercises regularly but can’t beat the genetics of high cholesterol/blood pressure, etc. What about the people who have to take medication for problem X and it casues severe weight gain and there is no way to get that weight off while staying on the medicine? How about people with type 1 diabetes or cystic fibrosis? Are they automatically out of the running because of a disease they were born with and no amount of healthy activity on their part can cure them of? This practice is just beyond absurd!!!

    1. Mimi Me*

      My daughter has a genetic condition and at age 2 had high cholesterol. Programs like these are awful.

  30. RinaL*

    Hey, I see a new bestseller book on the horizon: „How to get rid of your chronic depression in 6 months or less..“

    Honestly, the whole plan sounds so whacky that I am very glad to live in a country where healthcare is given to all people and not only those who can afford to pay for it. It has other problems – for sure, but at least nobody would even think about such insane plans!

  31. GothicBee*

    Yikes. Gonna be honest, I don’t even like how okay people are with stuff like charging smokers more for insurance because I think it will always be a slippery slope to even more overreach from insurance providers and/or employers. Smoking is an addiction and I really don’t think it’s that hard to jump from “smoking is bad” to “sugar is bad” to whatever the next “bad” thing is. I don’t think a smoker should be charged more any more than I think I should be charged more because I eat too much junk food (which I do).

    And “fixed” how??? Like are they gonna say “You have six months to lose 50 pounds”?? Because that seems like an astronomically bad idea on its own even if you don’t take into consideration how illegal this could be. This kind of thing is exactly why we need universal health care. Absolutely no one should be part of these types of health conversations except the patient and their doctor. The only way someone else should be included is if the patient chooses to involve someone else.

    1. HR Sister*

      I’ve seen the smoking surcharge in some companies, but it’s always been for people that turned down a cessation program – like they had the option to get help and refused it. Which is also not necessarily a great approach, but it is also really hard for smaller companies to fund healthcare. I don’t know if most people realize what a large chunk of their total comp it is when companies do a sizable cost share. So I do understand the flip side of trying to keep some manageable costs down, but this is how the programs like this pop up! PS – I’m also a proponent of universal healthcare!!

    2. Not So NewReader*

      A few states have banned a smoking surcharge and probably for this reason that it’s a slippery slope that can be something used to sledge hammer all different groups of people.

    3. Dream Jobbed*

      I thought smoker’s premiums were decreasing, because although they die younger (on average) they didn’t actually cost the insurance companies as much as many chronic diseases? (Again, on average.)

  32. Honoria, Dowager Duchess of Denver*

    I had a health insurance company once who offered extra incentives to people who did a health check. The difference being that the points were given for getting the check done rather than a “good” result. I loved it, as they’d offer £150 in cash once you’d done the test the proved you were a non smoker. £150 to continue to not smoke! Yes please :)

    1. Beautiful, talented, brilliant, powerful musk-ox*

      My employer does something similar. They give us a discount on our insurance premium for getting a check done. They used to require that we hit like four out of seven health markers or something, but now they just want us to do the check thing. I don’t love it because of my eating disorder history; it can be a little triggering. But it’s not the end of the world for me.

  33. Bananas*

    Alison, thanks for bringing up GINA in addition to the ADA on this. Most people are somewhat familiar with the ADA, but few understand GINA. GINA makes exceptions for wellness programs, but with specific requirements and this description of what is happening would be in violation. Even family history can be considered “genetic information” under GINA and employers can only obtain this information legally in a few way and they CAN NOT discriminate against an employee with that information, even if it was obtained legally.

    1. lazuli*

      I once got into an argument with a physician who was doing the pre-employment and yearly health screenings for a part-time job I had. He was using his regular family-practice intake forms, which included all sorts of questions about family history. I left them blank and wrote in that GINA prohibited that information from being used in employment health screenings. He told me that he couldn’t ethically treat me if I didn’t provide that information. I was like, You’re not treating me. You’re screening me for employment. Those are not the same thing.

      I complained to the employer and they just shrugged and said they never got copies of his notes so it didn’t matter. Which may be legally true, but it’s still crappy.

    2. Derivative Poster*

      Based on the OP’s description, I wasn’t sure how GINA would apply, though admittedly I know nothing about it. Let’s say the screening just included your BMI and a standard blood panel (cholesterol, etc.). Is that information protected by GINA?

      1. Sylvan*

        This is complete speculation, but familial hypercholesterolemia could come up. Homozygous familial hypercholesterolemia can have a pretty big effect on your health.

      2. Janet*

        Standard employer biometric screenings only include blood glucose, cholesterol, and BMI or waist circumference. I think it is unlikely GINA would apply here. If the employer was requiring a Health Risk Assessment, a questionnaire about the employee’s current health, then it’s possible they could run into issues asking about family history. A standard biometric screenings isn’t going to reveal any genetic information.

      3. Bananas*

        Generally biometric screenings/wellness programs shouldn’t reveal genetic information, but there is some ambiguity and interpretations or assumptions can be made that could negative impact the employee.

        ex:
        I have very low blood pressure as the result of a medical condition. Generally low blood pressure doesn’t get flagged like high blood pressure does, but it would be considered an anomaly outside the range of normal. I could be given 6 months to try to get my values closer to “normal”. My values will never BE normal, so I would not get the benefit of having my HSA funded by the employer. Now, I can try to fight it, but in order to argue that this is normal for me and I shouldn’t be penalized, I’d have to reveal disability and/or genetic information. If values were anonymized like they should have been, I couldn’t be singled out and discriminated against for lack of “improvement”.

  34. Ellie*

    So… they are basically trying to provide HSA only to those that don’t need it?

    Aside from the major, major ethical problems, legal problems, ableism, and whole pile of other ridiculous things in here…it just seems like a patently absurd way to determine who gets funding unless there goal is to get it back from employees when it’s not spent. (Do they get it back?)

    This is like telling incoming college students they have 6 months to ‘fix’ their financial problems, and those don’t have issues or do but ‘fix’ them get a bookstore stipend. Let’s give money to the people who are doing fine! As a reward! People who can’t ‘fix’ their entire financial situation in 6 months don’t deserve help.

    And…having written that out, that *is* how a lot of the US treats problems, financial or health, so I suppose I shouldn’t be surprised.

    Disgusted.

    2. Not So NewReader*

      “So… they are basically trying to provide HSA only to those that don’t need it?”

      My late husband was an insurance adjuster. He used to say the way to get insurance is to prove how much you do not need it. He felt the same way about the lending industry- if you can prove you do not need the money they want you.

      1. Ellie*

        Yeah, that rings true. We had to drop my good insurance when I was NINE because I got a kidney infection and they tripled the monthly cost, making it literally the same as our rent.

        That kidney infection haunted my premiums and eligibility until I turned 20 and could say it hadn’t happen in the past 10 years.

  35. Absurda*

    Well, since I don’t participate in an HSA I guess I’d have these folks beat and could continue to eat my M&M’s with impunity.

    Seriously, though, this is awful. As others have noted, some health issues can only be managed and most others just aren’t that easy to “fix”, whatever “fix” means.

    1. Nea*

      I remember that thread, because I remember writing down the bit about demanding a note in your chart and a copy.

      I had a neurologist call me in for a test result for a pinched nerve – only he wrote it up as “weight consult” and spent the entire time telling me my spine was fine, wasn’t that nice, but why don’t I try using this diet powder his wife lived on all Lent, it did her so much good? And if that failed, I could slice up my (healthy, functioning, nonproblematic) stomach & intestines in gastric surgery, hey, go to Mexico, it’s cheaper there.

      By the time I got the surgeon, he practically screamed “WHERE HAVE YOU BEEN YOU SHOULD HAVE BEEN HERE MONTHS AGO!” and warned me that the window for fully fixing the pinched nerve I went to the neurologist for had closed.

      1. Not So NewReader*

        s/Wow, that’s really scientific, an instance of ONE. So one person made out well with this product therefore everyone will?/s
        I can get that kind of advice from a friend or neighbor, I don’t need to actually pay money for that advice.
        And what happened to the concept of being scientific? It seems to be missing.

  37. ArtK*

    To add insult to injury, if they have an HSA, then they likely have a High Deductible Health Plan, meaning that everything costs an arm and a leg and you’re supposed to make it up on the HSA. The HSA isn’t a perquisite, it’s an absolute necessity.

    (Can you tell that I have a HDHP and throw a fit at every bill? Yeah, I have enough in the HSA to cover it, but it still hurts!)

    2. HR Sister*

      Yeah, you can’t have the HSA unless it’s a HDHP. But I will say, the HDHPs I’ve seen and worked with generally have lower out-of-pocket maxes, so depending on your situation (high cost meds, chronic conditions, child birth, etc.), you can actually end up paying less out of pocket in a year and premiums are usually lower too. Employer-provided insurance is so situational and so difficult if you don’t work with it in some capacity to know what you need. But when I had my son a couple years ago, I would have paid more on our company’s PPO than the HDHP.

      1. Anomalous*

        That’s been my experience too. High deductible plans can work well for people with high medical costs, as well as for those with very low costs. For people in the middle (most pe0ple!) they may not be a good choice. YMMV.

        It really depends on your specific needs and circumstances. Many traditional health plans have deductibles which are almost as high as those in high deductible plans.

        How I envy those outside the US who have no idea what we are talking about!

      3. Anon for complaining about health-not-care $$*

        Hahahahaha *SOB*

        The max I can contribute to my family HDHP is just over half the maximum out of pocket for my family (but it’s ALMOST enough to fully cover the maximum out of pocket for any individual family member). The DEDUCTIBLE is over half what I can contribute.

        My employer only offers high-deductible plans with HRA or HSA accounts. It sucks.

    3. Selina Luna*

      I only had an HSA when I had a healthcare plan that didn’t cover labs… in a town where simple blood draw costs over $1000. And I have an ongoing health issue that requires blood draws, quarterly.

  38. MissDisplaced*

    My company has a similar wellness program where if you complete a yearly wellness biometric (either in-house with a medical company that comes onsite or with your own doctor via a form) you receive a $250 credit towards your annual healthcare insurance costs. But that’s it. Employees can take the results to their doctors, or not. You are not obligated to do the screening at all, but then you don’t receive the credit. I imagine the company is given an general report as to the age/health of their workforce, but it is not at the individual employee level.

    HR pouring over individual results and requiring that employees “fix” their healthcare issues is really gross and the way this company is going about it is intrusive and gross.

  39. Sola Lingua Bona Lingua Mortua Est*

    Forget Worst Employer of 2021. This one has to be a candidate for Worst Employer of the 2020’s decade.

  40. Beautiful, talented, brilliant, powerful musk-ox*

    I have several health issues, but I know the one a lot of programs like this are hyperfocused on is weight, so let’s review the reasons my weight has fluctuated over the years:

    1. Eating disorder/disordered eating that ended up with me in an IOP program for ten weeks (that my insurance company paid $20k for). PHP was actually suggested, but my employer resisted me on that (it’s a long story).
    2. Went on and off a medication for a mood disorder (like, sorry I gained weight, but I think being mentally stable is more important so that I’m around to see that weight gain???)
    3. I have an autoimmune thyroid disorder that causes weight gain after a flare that is borderline impossible to lose. And between the time of the flare and being able to see my doctor 1-3 months later, I will be too exhausted to do much aside from go to work and nap. It’s not that I’m not “trying”.

    Literally none of these things could have been “fixed” in six months (arguably the medication, but what if it’s the only one that works?!). And that’s just me and JUST for weight fluctuations. There are so, so many chronic illnesses and disabilities that people have for life. There are a lot of acute illnesses that take longer than six months to get over.

    These people suck. If I found out this was a thing and was offered a job there, I would run in the other direction FAST.

    1. Kiki*

      The hyper-focus on weight of these sorts of programs (and arguably the medical establishment and society as a whole, but I digress) worries me as well. Since starting anti-depressants, I’ve gained weight despite being *more* active and eating more nutritious meals. Under this plan I’d be incentivized to lose weight, which would likely mean going off my anti-depressants. Based on my past behavior with untreated depression, I will lose weight, but be too depressed to exercise, be productive at work, or put together nutritious meals. I will not actually be healthier, but I will be thinner. And if I try to ignore the biometric screening and don’t lose weight, I could lose access to affordable anti-depressants? It’s just such a clusterfuck.

      1. metadata minion*

        I was mysteriously losing weight a few years back (luckily it turned out to just be appetite-suppressing medication — which this medication is notorious for, NICE OF YOU TO MENTION THAT WHEN YOU PRESCRIBED IT, DOC, WAIT, YOU DIDN’T) and when the NP was trying to look up information to give me to follow up after the appointment, it turned out that the only weight-loss related patient education the system had was on how to lose weight. Unexplained weight loss can be linked to some very serious conditions, but no, no need to cover that, let’s just encourage all our patients to be smaller. Fume.

        1. Beautiful, talented, brilliant, powerful musk-ox*

          The GP I used to go to is a part of a large healthcare system that started printing weight loss tips for anyone over a certain BMI threshold. Not only were some of the tips horrifying (like, things I’ve seen on pro-anorexic sites horrifying), but this got printed for myself and one of my friends — both of whom have had restrictive EDs. I wrote to someone about my concerns and asked if they printed weight gaining tips for people who were under the “healthy” BMI threshold (I know BMI is crap, but I was just playing by their rules). I’m sure you can guess the answer.

          Some parts of the medical field truly do not care about anything aside from your weight. And they don’t care how you lose weight as long as you get smaller. It’s disgusting.

  41. BubbleTea*

    Even worse, it’s “we’re going to give people with healthy bodies more money to use on staying healthy, and the people who arguably have greater need for help with healthcare costs can twist in the wind”. I just… wow.

  42. Teekanne aus Schokolade*

    Anyone else read the Digg advice column round up every Monday? I always guess which of the AAM entries from the week made it and this might be it. This is.. like absolutely evil. How big is this company? Has NO one pushed back yet?

    1. HR Sister*

      I think they’re between 500 and 1000 FTE. And multi-state presence. But they must not be getting pushback…

        1. Not So NewReader*

          OR the right person reads this column here. We have many upper echelon people reading here and they have friends….

  43. The Dude Abides*

    If companies are looking to cut costs on insurance, a prior employer had a benefit that made everyone happy.

    The deductible per year was 2k (3k when I left), but would reimburse in full the first 1k in expenses (upped to 2k with the change in deductible) the employee incurred for their own care. Just bring the bill, and you’d get a check on the spot.

    For 3-4 years running, 20% of the employees maxed this out for a number of reasons: pregnancy, broken bone, major surgery, etc. On the employer side, it was still more economical to do this than to pay the higher premiums.

    1. TiffIf*

      Just bring the bill, and you’d get a check on the spot.

      Medical bills often include entirely human readable information on what services were provided. This would be a terrible option for anyone who wants to keep their private medical information private.

      1. Sarah*

        I agree, this is a privacy nightmare.

        My employer has a Health Reimbursement Arrangement that allows them to reimburse us for the first $750 in expenses without seeing our actual bills. So much better.

    2. TootsNYC*

      this would certainly incentivize people to NOT put off going to the doctor for something sort of serious.

  44. Interviewer*

    Illegal wellness program. Wow. Wonder what else they’re getting wrong? Oh – paying bonuses under the table, you say? So they’re avoiding employer tax contributions and underreporting income. That’s gotta be it. I’m sure everything else is exactly by the book.

  45. Brett*

    I’m wondering how “nominal” is”nominal”. My company’s wellness program used to have incentives that could total several thousand dollars between discounts and bonuses, far more than the maximum employer contribution to an HSA. (The top discount amounted to around $3k/year while the top bonus was a $2.5k amazon gift card.)

    1. HR Sister*

      That is definitely not nominal! When I think nominal, I think like a $25 Amazon gift card. And even that needs taxed!

      1. Brett*

        Yeah, we had to pay taxes on the giftcards (as well as functionally on the discount, since that came off of tax sheltered premiums). The discounts for people with family insurance became very substantial.

    2. Daisy-dog*

      It’s possible the program that your employer uses does fit the qualifications of the ADA/GINA/ERISA/HIPAA/ACA/IRS. It’s complicated to do this, but it is possible.

    3. MCMonkeybean*

      $3k is a lot! Ours is a $40 discount per month which comes to $480 per year.

      And I think the important part is making sure that anyone can participate because there are a ton of different ways to get points–so while step-counting is one way there are also things like getting points for your annual physical and dentist exams and setting goals like “getting more sleep” or “eating more vegetables” and then checking off whether you did those things (you still get points even if you check the box that says “no I didn’t meet this goal yesterday.”)

  46. MsMaryMary*

    I work in employee benefits. Outcome-based wellness programs incentives are allowed under ACA, but this one is WAY out of compliance. HR should not have access everyone’s individual health data. Employers must offer a “reasonable alternative” to allow employees with a health condition to still qualify for the incentive. “Get better” is not a reasonable alternative. The incentive is way above the permitted maximum, and there are pending regulations that would only allow “de minimis” incentives for employees to participate. Think a water bottle or T shirt. Not a fully funded HSA. There are notification requirements regarding how the employer is conducting a compliant program, which are doubtless not being followed.

    If OP’s sister wants something to show her employer, she could start here: http://www.eeoc.gov/regulations/eeocs-final-rule-employer-wellness-programs-and-title-i-americans-disabilities-act

    There are hefty monetary and punitive penalties for violating HIPAA, GINA, and the ADA.

    1. HR Sister*

      Thanks for the link! I’ve always been in a generalist/business partner type role, and this is where the specialized benefits knowledge is really helpful :)

    2. Brett*

      Ah, that link helps for my question above. The total cost on our health plans are very high, so even with the $2.5k amazon gift cards and the discounts we would still be below 30% of the self-only plan. (And the wellness program was limited only to plan participants.) The gift cards were scrapped this year though, possibly in response to pending changes in incentives.

  47. NQ*

    I am writing this as a person from and currently living in the United Kingdom, who worked in the US for a few years: DEAR LORD.

  48. GreenDoor*

    I like my workplace wellness program. It includes:
    – replacing the food in our vending machines with healthy choices (we are an open worksite so we can still go out wherever for food)
    – hanging posters with “smart choices” information in our dining areas – no info pushes directly to indviduals
    – offering a balanced variety of physical movement classes, support groups, and indivudal virtual classes – all free, all voluntary, and all during the workday
    – registration for formal classes is through a3rd party vendor who only reports the enrollment count, not names to HR
    – sometimes we do fun classes taught by in-house staff. Those do not require registration – just show up and no record of who was there
    – no health screenings of any kind
    – participation is 100% voluntary and your participation or non-participation has ZERO impact on your health and time off benefits.
    This is how you ensure employees that you value their health and wellness – – and that you trust them to manage their own health matters

  49. Allypopx*

    “She thinks that they shouldn’t reward people who aren’t even trying”

    DEAR LORD THIS IS NOT YOUR PLACE. You either offer health insurance or you don’t. Employers are not entitled to monitor, moralize, or for god sakes put a price on private behavior. “Behavior” isn’t even going to be the issue in the grand majority of cases – health is not a morality indicator. Good god.

    2. HR Sister*

      Completely agree. I couldn’t quite verbalize to my sister this point because I was so taken aback when we were discussing it, but exactly this. I may have to copy and paste.

    3. Sylvan*

      AAAAA! Health doesn’t need to be punished or rewarded. (Improved health, for people who can achieve it, is pretty much its own reward!)

      Also, what about things that just can’t be fixed? No matter what I do, I can’t change a genetic condition. No matter how hard my dad works, he can’t make himself not epileptic (if someone invents a time machine, maybe he can go back and un-head-injure himself!). My coworker with progressive vision loss can’t cure that, either.

    4. Guacamole Bob*

      And who’s to say what “trying” even means? People are generally making the best decisions they can in the overall context of their lives. Sometimes that means they have lots of time and the mental and emotional ability and the work schedule and living situation to improve their diet and exercise a lot and get lots of sleep and do all the things their doctor might recommend for optimal health. And sometimes they don’t.

      We see this as a society – tons of people have been eating badly and not getting enough exercise and gaining weight due to the pandemic, and everyone intuitively understands that it’s not quite that people “aren’t trying”. It’s a result of the circumstances of stress and quarantine that has made certain kinds of healthful behaviors less feasible for people. Should you get an exception on the company’s ruling that you “weren’t trying” this year? And if that’s grounds for an exception, what about the year that you gained weight and your cholesterol went up because you were practically living from the vending machine at the hospital where your loved one was going through extensive treatment? Or any of the multitudes of other things that keep people from doing the things that might be nominally under their control to improve their health?

    5. Paris Geller*

      Yup. Also–there’s a lot of health conditions you can’t “try” on, and those tend to be the chronic conditions that are costliest to treat!

    6. Third or Nothing!*

      That’s the phrase that made me mad too. I’m a runner and my food allergies mean my diet consists mostly of whole foods that I prepare myself. I’ve been working from home for a year now, which means extra time for running since I don’t have daycare dropoff or a commute any more. Which is great, because running is the last healthy outlet I have for stress and anxiety left. I doubled my previous record for most miles ran/walked/hiked in a year. And guess what? I still have asthma and PCOS and anemia and a high BMI. You can do all the “right” things and have the main benefits be how you feel mentally or physically, which can’t be easily measured. And there’s no moral obligation to even DO the “right” things in the first place!!

  51. thatoneoverthere*

    This is horrific. I am not even a fan of those discounts you get for going to the doc for physical them turning in a sheet of all your measurements and weight. I am not normally a “conspiracy” type person but I just don’t trust them. I have zero to little faith in insurance companies.

  52. Silly Janet*

    Ding ding ding! I believe we have a contender for worst company of the year award!

    If they have ways for me to “fix” my two autoimmune conditions, I would love to hear it.

  54. Tbubui*

    Well this is appalling and ableist. So my genetic condition that can’t be cured (short of some extreme genetic therapy that doesn’t even exist yet) means I couldn’t have an HSA? Wow OP, your sister is just so wrong about this. And the company is frankly disgusting because of this policy.

  55. Cube Diva*

    YEAHHHHHHH this is terrible. My company does a similar biometric screening, but everyone gets the same HRA benefit for participating. And it is completely voluntary. I hope someone finds out about this program and shuts it down.

    1. Batgirl*

      I was thinking that any reporter with the right (or wrong) health stats, interested in ableism issues could do a hell of a first person undercover here.

  58. Tobias Funke*

    Every time I feel crazy for being really uncomfortable with how our society is set up, I read something like this, so thank you for sharing. This is an absolute nightmare.

  59. Ubi Caritas*

    I had a bad fall two years ago – walking across my living room, no idea why I fell. I broke/dislocated several bones in my foot, needed surgery and a MONTH in rehab – and still not properly healed. It doesn’t always matter how strong your will is, how much you want to get better, sometimes your bones and muscles just don’t. Or you may develop severe arthritis in the damaged joints. If it were just a matter of determination, I’d be running marathons, instead of struggling to stand while I scramble eggs.

  60. Firecat*

    Wow. It’s taken 2 years, yes years, to find out that my chronically numb leg is due to something in my back. The first round of testing was inconclusive and we had to wait for it to worsen before testing again.

    I still have to go through more testing to even find out what it is in my back causing it! Then I imagine we are looking at months to years of monitoring or treatment.

    But yeah if I “am not even trying” to fix the health issue why should I get any of the financial assistance for these expenses. >:c

    1. Sally*

      A family member went through a very similar issue with progressive leg numbness and it was an absolute nightmare to get a diagnosis. It took a lot of patient advocacy, persistence and multiple trips to different specialists over a period of 1.5 years. I can only imagine how much worse it would have been if we also had to deal with a crappy policy like above. The healthcare system makes me so angry on some days and as horrible as it may sound, I am glad that people like you share experiences that validate my anger. I sincerely hope you get a diagnosis and the required treatment soon x

  61. Who Plays Backgammon?*

    I was eating chocolates when I read this. Honest.

    This is why I strenuously object to so-called “wellness programs.” They are rife with opportunities for abuse. If I want health information, I have a personal physician for that and he doesn’t rat me out to HR for gaining 3 pounds or doing extreme sports like shopping the mall on Black Friday. I don’t trust that my information is private, because someone has it and, however innocently, one accidental click of a mouse, and…

    If employers want to save money on employee health and insurance, they can get behind the idea of good-quality national health coverage for everyone, regardless of where they work.

  62. Anonymous Worrier*

    Does the ADA restriction extend to companies who require their employees to get medical exams but do not receive any information about the results? My company has a $500/year health “surcharge” that is waived if you have an annual physical. The results of the physical are not reported to the company; you only need to provide proof that you saw your doctor. I’ve never liked this requirement and I’m wondering if it’s illegal, or if the fact that the employer doesn’t get any private medical information would allow it to squeak by.

  63. Mystic*

    This is not a good idea… and there’s so many things you *can’t* fix. I used to have a heart murmur, since I was born…now, it actually did fix itself, but it took 20+ years to do so.
    Also, scoliosis and inflamed joints, neither of which are easily fixed.
    This company’s plan is not good, at all.

  65. My Boss is Dumber than Yours*

    This reminds me of an ex-girlfriend of mine who was still on her parents insurance when we were dating (we were early 20s and she was staying on there’s till she turned 26 and using it as an opportunity to freelance). Her dad worked in sales and was on a company-funded plan, and his manager started threatening to tie approval of claims to meeting sales quotas. He apparently even tried to deny coverage for an employee’s child’s birth because said employee had less sales year-over-year (obviously, as they were on maternity leave…)

      1. HR Sister*

        This made me laugh! But, also, seriously WTF?! I have never heard of a company doing that, and wow. It may have absolved me of every rookie HR mistake I’ve ever made??

        1. My Boss is Dumber than Yours*

          For what it’s worth, I don’t know if the *company* was actually letting the boss do this. I should have been clearer that all I know is that he threatened to try to deny coverage, not that he ever actually went through with it or if he was successful in doing so. I broke up with my girlfriend not long after all of this started happening. I do know, however, that her father skipped his yearly physical and rescheduled some other preventive care/screenings because he wanted to save money for his kids care of boss did decide to be King Ass.

  66. Llellayena*

    So…your biometric testing revealed that you have diabetes (and have had it for years). You have 6 months to fix that or we’ll refuse to fund your HSA…which you’re using to be able to afford your insulin.

  68. I Wrote This in the Bathroom*

    I am curious, outside of the short-term monetary savings, what is this employer’s end game? If they pull their HSA match from those of their employees who need it the most, those people are as a result going to… go to the doctor less because they cannot afford it now? get more sick? die?! And that is supposed to help the employer’s business how? Ugh, this kind of short-term thinking is my pet peeve. (Obviously aside from the multitude of discrimination issues that everyone has already pointed out.) It’s like that old joke about a farmer who was training his horse not to eat in order to save money; and had almost trained it, when the horse suddenly dropped dead for no reason he could think of.

  69. MikeN*

    I really don’t have any value to add here, but I felt compelled to comment on how completely disgusting this is, and how clueless people can be when setting up programs like this. I’m sure that plenty of earlier commenters have expressed the same thought more eloquently, but I just had to add my comments in case the universe is keeping score.

  70. iglwif*

    this seems purposefully designed to take away health care funding from the people who are most likely to need health care funding, which is … an unusually high level of evil IMO

  73. Analysis Paralysis*

    On top of all the other ways this is messed up, the appeal of employer-sponsored healthcare in the US was specifically because (pre-ACA) it want the only way to get around insurance companies punishing people for “pre-existing conditions”! It’s the same logic behind employers offering other group insurance benefits that might otherwise require medical screening (life, long term care, etc.)

    An open letter:
    Dear employer sponsored health benefits that discriminate based on health status,

    What even is the point of you?

    No love,
    Me

  74. Keymaster of Gozer*

    It’s a statement of how much the past year has destroyed my faith in….a lot of humanity, that this actually doesn’t surprise me. Disgusts me, yes.

    For the last year I’ve had a constant ‘the old, infirm, fat etc. people should just lock themselves away for good or die so the ‘normal’ folks to get back to life’. I’ve never felt so disposable.

    So a company doing a ‘your conditions are all YOUR problem and we’re not paying for any of it’ is like 2020 all over again.

    I sincerely hope they get the full might of the law/regulations crashing down on them. Please, give me some hope 2021….

    1. Third or Nothing!*

      Disposable is exactly how I have felt the past year too. I have learned some things about my country, my state, my friends, and my family that I cannot unlearn.

  75. TootsNYC*

    We’ve ended up here because of our ridiculous system of tying health insurance to employment (which is probably in the top 10 worst decisions in the history of the republic), but this is way over the line.

    You watch–if we end up in a taxpayer funded health-insurance / health-care situation, this is still going to be a problem, but it’s going to have the weight of law behind it.

    And if it missing the “weight of law behind it,” it’ll have public shaming and nasty comments all over it.
    You think fat people get rude comments in restaurants now? (they do)
    Just you wait until Americans can say, “My taxes are paying for your health care, so you shouldn’t eat that fried food in the restaurant.”

    2. Ask a Manager* Post author

      I think people might be willing to deal with occasional rude comments in exchange for not dying from lack of accessible health care. (Not that they should have to. But fear of that is in no way a reason not to give people access to necessary health care.)

      1. My Boss is Dumber than Yours*

        100% agree. Toots comment is the healthcare equivalent of opposing freedom of religious expression because people might harass women wearing hijabs.

        1. TootsNYC*

          did I say that I oppose a taxpayer funded solution to health care?
          I don’t–not in the least!

          I just see this as becoming one of the downsides.

      2. TootsNYC*

        I hope I didn’t imply that it was. I’m majorly in favor of taxpayer-funded health care or health insurance. It can’t come fast enough.

        I just think that our obsession with weight, a general resentment toward paying taxes, and a basic belligerence is going to make those encounters happen. They already happen, but nobody can say, “My tax dollars are paying for this; it has to happen the way I personally want it.”

        1. Susana*

          Right, but people say that already – in terms of their group health insurance premiums being higher.

    3. I Wrote This in the Bathroom*

      They already can, to Medicare and Medicaid members. Admittedly those on Medicaid do get a lot of extra scrutiny (because, ya know, being poor or too sick to work is a character flaw around here *eye roll*) But Medicare members seem to be doing just fine in terms of receiving public judgment.

    4. Amethystmoon*

      I hardly ever go to restaurants now unless I am with other people. I’m certainly not going to go by myself if that happens. There’s more than one reason I learned how to cook.

    5. Tuesday*

      Hypothetical jerks are not going to make me think we shouldn’t have universal healthcare, but also, I don’t even get this argument. First of all, the overweight person very likely pays taxes too and maybe more than the jerk in this hypothetical scenario. But also, people could say, my taxes are paying for your kids’ education, so they should be studying more. My taxes pay for the roads you drive on, so stop taking unnecessary trips. But we don’t stop funding public education and roads because of these hypotheticals.

      1. TootsNYC*

        I’m sorry I wasn’t clear–this was not intended to be an argument against universal health care. I am totally in favor of universal health care.
        I just see a core nastiness in many American taxpayers, and it is going to come out.

        1. Tuesday*

          Ah, gotcha – I get what you’re saying now. We probably do have a rocky road ahead, but I hope in time accessible health care will start to seem like a normal, expected thing.

        2. pancakes*

          I don’t think referring to people as taxpayers at every opportunity to do so is going to help that mindset go away.

    6. Not So NewReader*

      Until we cure the core problems we will continue to have layer after layer of problems.

      We (society) used to be rude, now we (again, collectively) are way out beyond rude. Some how we need to get back a culture that does not accept rudeness. Personally, I think if people feel “heard” they are less apt to say rude things.

      Next we have a medical system that is way too labor intensive and cost intensive. Until procedures and processes are streamline for efficiency it doesn’t really matter who foots the bill, that is going to be one big bill.

    7. Maltypass*

      I mean I live in the UK and I have literally never heard those words uttered – if someones gonna be ableist they’ll use any justification

      1. TootsNYC*

        I think that’s a difference between America and the UK (maybe all of Europe).
        A number of Americans already say to government employees, “I pay your salary, you have to do X for me.”

      2. Keymaster of Gozer*

        I have, but arseholes are endemic to any country, regardless of how the healthcare is funded.

    8. allathian*

      I’ve lived in a country with single-payer healthcare all my life, and I’ve been fat or obese most of my adult life. I’ve never heard anyone judging what I eat in a restaurant, or what food I choose to buy, or whatever. I’m also very happy that I won’t lose access to healthcare if I lose my job.

  77. PhoebeRuns*

    I am horrified by this. My daughter (age 10), has Type 1 diabetes. There is no cure. I’m appalled to think that this might be something she comes up against in her adult life. Ugh…just so gross of this company.

  78. Daisy-dog*

    I actually just attended a webinar about all the laws governing wellness programs. An appropriate de minimus reward for participation in a wellness program is a water bottle. Not $3600. If they want a protection from having to pay that out to all employees, then just stop paying that out to all employees.

  79. cbzpr*

    I came only here to say I agree with Allison 100% that the employment based insurance environment is horrible and makes things so much worse when people need the insurance the most.

  80. PivotPivot*

    I would really like an update on this. Hopefully OP will be able to tell us that after she showed bad sister Alison’s comments and the rest of the AAM community’s responses, that there will be a positive outcome, like have the company step WAY back from their current overstep.

  81. Ben Marcus Consulting*

    All of the reasons why this is illegal are great. One more to add, this wouldn’t pass comparability testing for HSA. Based on how this is presented, it’s clearly not funded through a cafeteria plan, which means the funded approach needs to be uniform and ‘discrimination’ can only happen for very specific circumstances.

  82. agnes*

    I would also like an update on this one. It’s hard to believe in this day and time that a company could be so clueless and so obnoxious. I hope this gets taken care of quickly and appropriately.

  83. Amethystmoon*

    I would love to know how I’m supposed to fix in six months my genetically inherited hypothyroidism and my chronic idiopathic hives, both of which are from the same side of the family tree and I will have to take meds for the rest of my life, unless a miracle cure happens that will also be affordable.

    1. Amethystmoon*

      BTW the chronic idiopathic hives often happen late at night, despite the meds, so that doesn’t exactly help the weight issues that come with the hypothyroidism. The alternative would be shots, and I’ve been told co-pay is in the hundreds of dollars. Maybe I’ll take them when I win the lottery.

  84. Cj*

    A former employer of mine had five things we were screened on. Blood pressure, if we smoked, BMI, cholestoral and one other thing. We would get $500 towards our $2,500 deductible for each one we were “OK” on. Kind of the same things as this. It is one of the largest employers in south central MN (not 3M, though).

    1. OyHiOh*

      Possibly Hormel?

      Have family in that general neck of the woods, who work for a large employer with the same name as a condiment ;-)

    2. Not So NewReader*

      I love this one also. (NOT)
      This assumes that each household has 2k floating around for each person in that household. This is dreamworld stuff.

  85. animaniactoo*

    Do I get a discount for my completely genetic (father and older sister have it too) through the floor – that’s right, the floor, not the roof – cholesterol level?

    Cuz our cholesterol levels used to REALLY piss off my mom. She with the level through the roof and was the only one of us to purposely and regularly healthy.

    Also, define “trying”. If I am doing MORE than I otherwise would because of a wellness benefit, but am still not some target of wellness, or I do try and I exercise quite a lot but am still weak when it comes to the onion rings, how does that count as “not even trying”?

  86. LivetoRead*

    Additionally, an employer who offers a wellness program is required to offer a similar program to those who can’t participate in the incentive i.e. if you are overweight but can’t walk or exercise sufficiently to meet the program requirement, you have to be offered a similar opportunity that you are able to complete to earn the credit. This program is completely illegal. It also violates HIPAA

  87. 10Isee*

    Reading the phrase “not even trying” hurts my heart.

    I have genetic conditions that affect how my body processes and stores energy. Just to avoid any more hospitalizations, I exercise several times a day and eat a low-fat, low-carb, no-sugar, gluten free diet, along with taking several meds. My bloodwork is still bad, but it’s “daily pain and GI distress” bad instead of ICU bad. I cannot fix my bio markers in six months. That doesn’t mean I am not trying. I promise you, I am trying! Making this diet work on my budget is a struggle. Getting exercise in while parenting and running a home and working is a struggle. I am trying! But the genetic lottery just didn’t go in my favor.

    1. Third or Nothing!*

      Solidarity, fellow spoonie. I also exercise a lot and eat a specific diet partially to address symptoms of my PCOS and partially due to food allergies, and my bio markers haven’t changed much since I figured out doing these things helps me feel better. But I went from “curled up in the fetal position on a regular basis” to “sometimes feel like crap on a stick but can function” so it’s still a big win for me.

  88. Not So NewReader*

    This company should only hire healthy people. Once they become sick or “sickly” the people should leave.
    Oh wait. That’s the goal here.

  89. Allura Vysoren*

    I…my employer required us to complete biometric screenings this year (yes, during a pandemic, with two weeks notice) and, if we didn’t complete the screening or didn’t pass, we had to pay higher insurance premiums. I have some very serious questions.

    1. Sally*

      Mine is like that too but if we don’t participate, we are charged a monthly, $25 non-participation fee and are not eligible for a premium health insurance plan. And we are awarded “points” based on height, weight, waist circumference, blood pressure, glucose and cholesterol. We can earn “points” by walking, running, losing weight etc to avoid the penalty. It’s awful. If we earn X points, no penalty. If Y points, we get a $25 monthly credit. If Z points, we get a $50 monthly credit.

  90. Pigeon*

    This is code for “our company feels fat and disabled people don’t fit our image” and they’re trying to find a legitimate-sounding way to enforce that. Gross.

  92. Roci*

    I am not in the US and don’t fully understand how a HSA/employer-provided health insurance works… but if OP’s sister was right and the company wanted to be generous and incentivize people to improve their health, wouldn’t they offer more affordable health insurance plans? Rather than contributing to a savings account so people can pay it themselves, since their plan provides minimal care?

    And that logic presumes that the company is trying to reward/punish people for how they manage their health? So it’s OK for a company to punish someone for being sick? Does battling chronic illness count as a “professional development” goal now?

    Just….what? I can’t make this make sense in my brain.

  93. MBK*

    This is absolutely horrible, and it gets even more horrible when you realize that the company’s response to getting reported/called out will likely be to cancel the entire HSA benefit rather than give it to those it currently excludes.

  94. wee beastie*

    I’m imagining a whole slew of employees who started physical activity to get free, fully funded HSAs ending up with stress fractures, tendinitis, pulled muscles, sprains, torn ligaments etc and needing expensive orthopedic treatments that the company has effectively paid for. I picture some boss looking around at people in slings and braces and empty desks for other employees home on bed rest and thinking, “hmmm, this isn’t what we intended.”

  95. Good Vibes Steve*

    Actual jaw-drop.

    No, no, no, no.
    No, I don’t want HR to have access to my health information.
    No, I don’t want my company to attach judgement to my personal health.
    No, I don’t want my access to benefits to be linked to the judgement.
    No, I don’t want to ever have to justify my health record to HR.

  96. Matt*

    OMG. Since you mentioned hypertension, I’d never be able to get out of that thing … I have hypertension and take BP lowering medication – but to find correct dosage, every doctor had to rely on my honest report of my self measurements. Entirely. When I take my pills, don’t drink much alcohol and have no unusual level of stress, I get perfect readings of 110/70 to 120/80 at home on my couch, but whenever I’m at a doctor’s office, they’ll get readings like that of a man being led to the execution chamber. I have anxiety of that particular situation and there’s nothing I can do about this – I learned the condition even has a medical name, the “White Coat Effect”. I’d never be able to prove that my BP is under control.

    1. allathian*

      I’m the same way. I have healthy BP when I measure it at home, but not at the doctor’s office. I’ve resorted to asking my husband to take photos of our blood pressure meter with my phone, so I can show the numbers to my doctor. Now she trusts me when I show her the journal.

  97. Less Bread More Taxes*

    I did a quick search of the comments, and I’m shocked there haven’t been any Europeans jumping on about this! I have lived and worked in two European countries, and in both, medical exams were required in order to sign contracts. I don’t know of a single person who hasn’t had to do one except for contract roles that are based entirely outside the office. It’s so extremely common here for your employer to have access to sensitive medical info and it’s extremely possible for them to punish you for your health.

    I hope your sister’s coworkers are able to band together around this. Boy do I wish that was an option here. I miss those ADA laws.

  98. it's me*

    I worked at a pharmacy benefits management company and would be a listening party on calls with employers wanting to use the service. They definitely talked about and were aware of (although they didn’t name names) who was costing them what. That’s how I learned that there were monthly injections that cost tens of thousands.

  100. EngineerMom*

    This is so, so wrong.

    Employers have zero right to financially penalize people for their health.

    Aside from the “should they even see this information issue”, pretty much ALL the research indicates that shaming or otherwise negatively “rewarding” people for lifestyle issues doesn’t work long term.

    If this company is THAT interested in improving its employees’ health, it should:
    1. Make sure vacation and time off is sufficient, available, and fully supported by management.
    2. Restructure the campus to make it more walk- and bike-friendly
    3. Support infrastructure changes in the community to decrease time spent in cars, availability of walking/biking.
    4. Sponsor or support local gyms, including compensating employees for gym memberships.
    5. Revamp cafeteria offerings (if there’s a cafeteria on site) – ours did this to include a much better salad bar, and it definitely had a positive impact on my diet!
    6. Make the entire campus smoke-free.
    7. Reimburse employees for things like cooking classes (or partner with local chefs to provide lower-cost cooking classes).
    8. Sponsor/support local athletic events like 5k runs, cycling events, yoga events, etc.

  101. Seashells*

    We have a “wellness” program where I work, but it’s not like the one in the letter. We do the biometric screening but HR doesn’t get the results and it doesn’t affect our HSA contribution from our employer.

    I have hypothyroidism. Nothing I did or did not do caused it. It just happens to some people. I take the meds, I follow the doctor’s advice, but I will have to take meds the rest of my life. If my company tried to penalize me for this, I would job hunt. When I got another job, I would do my best to contact news outlets and file reports and let as many people and agencies as I could reach what this company is doing.

  102. Kaisa (The Librarian)*

    Honestly, I find the biometric screenings and health points and “challenges” in general to be squicky, and my employer stays fairly removed from it, but I’m cheap and there is a slight premium discount if you hit target points. Even in the best of programs I think it is an overreach and pointless – and really just illustrates one of the many reasons that insurance should not be tied to employment. And regardless of legality it bothers me on so many levels that this policy penalizes the people that might need the benefits the most.

  103. Nikki*

    Yuck! I hate this!

    I live with a genetic disorder that requires a lot of management. (Last month, for example, I had twelve doctor’s appointments. I have to stop 4-5 times a day to handle medication. And I spend a small fortune on healthcare every year.)

    It’s not a competition, but I spend a lot more time on “wellness” than most people my age.
    Still, I guarantee that I’m never getting the “wellness” bonus, because despite my best efforts I’ll never be healthy. I’ve always disliked wellness programs for this reason — they reward results rather than effort.

    I think many employers see this as a harmless cost-saving measure. As Allison says, they need to consider the effect on morale, and the way this discriminates against people living with incurable health conditions.

  104. Anonymous For This One*

    Wow. Part of the reason I cannot lose weight is because I’m on antidepressants and birth control to treat wild swings in hormones.

    I could go off this medication to lose weight, but I’d be non-functional. My doc and I have decided the weight gain is worth it, given that I’m now willing to get out of bed.

    I’ll take my medical advice from my doctor, not my employer. And I would be taking my fat self to a different employer, and talking to a lawyer about whether this is ADA territory given the medication I’m on.

  106. P*

    Ha, I’d love to see them tell me I have 6 months to cure my genetic disease. I have a rare condition and one thing attributed to it is severely low vitamin D levels. I have had doctors before tell me if I just went out in the sun more…I live in a very sunny state but my body absolutely cannot absorb vitamin D correctly. I could drink 3 gallons of milk and get nothing.

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