Encourage Your Staff to Appeal Prior Approval Denials; They May Win
October 13, 2026
Employees who put off recommended screenings or struggle to manage chronic conditions can develop complications that require expensive treatment. For employers facing rising group health insurance costs, encouraging workers to stay on top of preventive care and seek appropriate care earlier offers a way to address some of the claims driving those increases.
One way employers can do that is through a points-based wellness program, which rewards employees with lower payroll deductions for health insurance when they attend health screenings, keep up with vaccinations and take steps to improve their health.
How the programs work
With these programs, employers work with a wellness plan administrator to establish a menu of eligible activities, assign point values and set a threshold employees must reach to earn a reward. A benefits platform or program administrator tracks participation and verifies completed activities.
Employees might earn points for:
- Attending an annual physical or dental checkup.
- Receiving recommended cancer screenings or vaccinations.
- Participating in diabetes education or health coaching.
- Completing nutrition, exercise or stress-management activities.
- Attending financial wellness sessions.
Employees who reach the required point total receive a discount on their health insurance contribution, often for the following plan year. Offering several ways to earn points helps workers choose activities relevant to their needs.
Shay Garrioch, chief human resources officer at the Culinary Institute of America, told Plansponsor, a trade publication, that the institute introduced a points-based program to encourage spending on smaller, proactive health care that might prevent larger claims later.
Employees who accumulate enough points receive a 10% premium discount the following year. Qualifying activities include physicals, dental visits, women’s health screenings, fitness challenges and meetings with a financial adviser. Garrioch said the institute has significantly reduced the frequency and cost of severe claims.
Where potential savings come from
The employee’s discount does not automatically reduce the health plan’s total premium or claims expenses. When an employer lowers the worker’s contribution without a corresponding reduction in plan costs, it generally assumes more of that expense. Administration and incentives also carry costs.
The potential financial benefit comes later, if participation helps employees avoid complications or manage existing conditions more effectively. Connecting someone with diabetes to ongoing treatment, for example, may help prevent an expensive hospitalization.
Self-funded employers pay claims directly, so lower claims can reduce their costs. For fully insured employers, improved claims experience may lead to more favorable renewal pricing, although medical inflation, the insurer’s rating practices and other factors also influence premiums.
Savings are not assured. A randomized study published in Health Affairs found that a workplace wellness program improved some reported health behaviors but did not significantly reduce spending after three years. Employers should evaluate results rather than assume participation alone produces savings.
What employers can do
- Work with your broker or administrator to prioritize appropriate preventive care and chronic-condition support.
- Explain how to earn points, meet deadlines and qualify for the premium discount to employees.
- Offer accessible activities for employees with different abilities and schedules.
- Have advisers review incentive rules, privacy protections and applicable wellness requirements.
- Track participation, claims trends and total program costs over several years.
The strongest approach connects rewards with useful care and follow-up support, giving employees an immediate financial benefit while pursuing better long-term health outcomes.
