ADA: Disability-Related Inquiries and Medical Examinations - Health Risk Assessment - March 6, 2009

Sep 21, 2026

Letter response addresses whether requiring employees to participate in a Clinical Health Risk Assessment (CHRA) to qualify for health insurance coverage violates the Americans with Disabilities Act. It explains ADA limits on disability-related inquiries and medical examinations before and after a job offer, and when such requests are job-related and consistent with business necessity. It also discusses rescinding the prior inducement guidance tied to wellness programs and states the Commission continues examining permissible financial inducements.

LanguageEnglish

CategoryHealthcare

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Pages2

Reading Time5 min

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ADA: Disability-Related Inquiries and Medical Examinations; Health Risk Assessment

Background and prior response (Jan. 6, 2009)

Questions presented (Aug. 7, 2008)

ADA framework for disability-related inquiries and medical examinations

CHRA requirements and applicability to business necessity

| EEOC Office of Legal Counsel staff members wrote the following letter to respond to a request for public comment from a federal agency or department. This letter is an informal discussion of the noted issue and does not constitute an official opinion of the Commission. | | --- | | ADA: Disability-Related Inquiries and Medical Examinations; Health Risk Assessment
March 6, 2009 [ADDRESS] Dear :
On August 7, 2008, you sent this office a letter asking whether County may require employees to participate in a health risk assessment as a condition for participating in its health insurance plan. In a letter dated January 6, 2009 from former Legal Counsel Reed Russell, we responded that although the Equal Employment Opportunity Commission (“EEOC” or “Commission”) has not taken a formal position on this issue, this office believes the policy you described would violate provisions of the Americans with Disabilities Act (“ADA”) that require disability-related questions or medical examinations of employees tobe job-related and consistent with business necessity. See 42 U.S.C. § 12112(d) . Our response went onto describe the circumstances under which employers could offer employees inducements to participate in wellness programs without violating the ADA. We said that a wellness program would be considered voluntary and any disability-related inquiries or medical examinations conducted in connection with it would not violate the ADA, as long as the inducement to participate in the program did not exceed twenty percent of the cost of employee only or employee and dependent coverage under the plan, consistent with regulations promulgated pursuant to the Health Insurance Portability and Accountability Act (“HIPAA”) .
Because your letter did not raise the question of what level of inducement to participate in a wellness program would be permitted under the ADA, we are rescinding the portion of the January 6, 2009 letter that discusses this issue and have enclosed a revised version of that letter that answers only the specific question you asked. The Commission is continuing to examine what level, if any, of financial inducement to participate in a wellness program would be permissible under the ADA.
I hope this information is helpful to you.
Peggy R. Mastroianni
/s/
Associate Legal Counsel
ATTACHMENT | ADA: Disability-Related Inquiries and Medical Examinations; Health Risk Assessment March 6, 2009 [ADDRESS] Dear : This responds to your August 7, 2008 letter to the Office of Legal Counsel, Equal Employment Opportunity Commission (EEOC), in which you pose the following question: “Does the requirement to participate in the [Clinical Health Risk Assessment (CHRA)] . . . to qualify for participation in the [ County (County)] health plan constitute a violation of the Americans with Disabilities Act?” Your letter states that the County has implemented the CHRA “as a requirement to obtain coverage under its selffunded plan.” Employees must agree to participate in the CHRA, which includes answering a short health-related questionnaire, taking a blood pressure test, and providing blood for use in a blood panel screen. Employees declining to participate in the program and members of their families become ineligible for coverage under the County’s health plan. Your letter also notes that information from the health risk assessment goes “directly and exclusively” to the employee; the County only receives information in the aggregate. Title I of the Americans with Disabilities Act (ADA) limits when an employer may obtain medical information from applicants and employees. Before a job offer is made, the ADA prohibits all disabilityrelated inquiries (i.e., questions likely to elicit information about a disability) and medical examinations, even if they are related to the job. After a conditional offer is made, an employer may ask disabilityrelated questions and require medical examinations as long as it does so for all

FAQs

What question does the letter address regarding the ADA?

It addresses whether requiring employees to participate in a Clinical Health Risk Assessment (CHRA) to qualify for participation in a county health plan violates the Americans with Disabilities Act.

How does the ADA treat disability-related inquiries and medical examinations before a job offer?

Before a job offer, the ADA prohibits disability-related inquiries and medical examinations, even if they relate to the job.

When can an employer require disability-related inquiries or medical examinations after employment begins?

Only when they are job-related and consistent with business necessity, such as when there is a reasonable belief based on objective evidence that an employee’s essential functions will be impaired or the employee will pose a direct threat.

Sep 21, 2026

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