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Insurance Wellness Checkup: Are You Covered? | North Woods Associates

A regular check-up with your physician is a preventive measure against underlying diseases or anticipating illnesses that come with your family background, workplace hazard or lifestyle. Even if you think you are already healthy, it’s wise to take advantage of wellness check-up given by your company. As an employee, you need to know what your company offers and the impact of wage and hour law on this matter.  

Wellness exams

These are preventive care that focuses on maintain health state or stopping diseases before they happen. When you visit your physician for this check-up, you are ensuring your wellness before any problems arise.

These exams happen once a year that is unlike a check-up you do whenever you’re experiencing symptoms and/or injuries. Insurance companies usually pay for the wellness check-up but some tests and exams may be excluded. Policyholders should ask their insurance companies as to the coverage (and limitations) of such exams.

Wellness check-up coverage usually includes:

  • Physical exam
  • Vital signs checking such as blood pressure
  • Body mass index for weight checking
  • Assessment of family and medical history
  • Basic screenings such as blood sugar, mammogram, and cholesterol
  • Immunizations
  • Creating a health plan based on wellness assessment

Doctors may also ask about your current lifestyle, physical activity, workplace environment, and activities. Whenever you take your annual physical exam, it is best to disclose to your physician’s necessary details such as tobacco and alcohol use so your doctors can come up with plans and work together for the best outcome.

Health Plans

Group health plan is a benefit established between the employer and the employee (like the union) that provides medical care through insurance.

This is an aspect covered by Employee Retirement Income Security Act (ERISA). ERISA also protect participants and their beneficiaries’ rights which also include retrieval of plan information. Employee Benefits Security Administration (EBSA) is the entity that enforces these provisions coming from ERISA. EBSA gives information about the participant’s health plan and compliance assistance for employers.

The Fair Labor Standards Act (FLSA), however, does not work on wellness benefits and insurances. If you need things to know about wage and hour, you can find it in FLSA. With medical care, it is an agreement dealt between the employer and employee (or his/her representative).

It is in the wage and hour law employees need to look into for standard wages and overtime pay. The standard minimum wage and overtime pay varies in different states but the federal law establishes this baseline wage rate across the country. For those covered by the federal law, employers need to pay the federal minimum wage of $7.25 per hour with a 40-hour work week. Anything that goes beyond this duration might require employers to pay at least one and half-time the rate of an employee’s standard hourly rate.

In the cases of insurance covered wellness check-up in some states, it is mandated in FLSA that employees need to be paid their hourly minimum wage without deductions (free and clean). Though deductions are not forbidden, an employer must not reduce wages as pointed in the FLSA minimum wage mandate. However, insurance premiums are part of the permitted deductions if they are paying to independent insurance agencies when the employer is not obliged to provide insurance or benefit from it.


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