BofA GINA Notice
Wellness Program GINA Authorization Form
The Bank of America, N.A. (“Company”) Wellness Programs (the “Programs”) are voluntary wellness programs available to eligible employees of the Company and their spouses participating in certain of the Company’s major medical plan options. Employees and spouses participating in the Programs can earn financial incentives such as lower premium contributions. The Programs are administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others.
To the extent applicable, by signing this authorization form, I, the spouse of the employee named above, am requesting to participate in Programs that may include the following:
- Health Risk Assessment. This type of assessment may ask questions about your health-related activities and behaviors and whether you have or have had certain medical conditions (e.g., cancer or heart disease).
- Biometric Health Screening. This type of screening may include meeting with a healthcare professional to collect information such as your height, weight, waist circumference, blood pressure, total cholesterol, and HDL cholesterol.
- Completion of a Tobacco-Cessation Program. This Program may provide incentives to employees and their spouses who do not use tobacco products, who attest they intend to stop using tobacco products in the upcoming plan year, or who undertake tobacco-cessation programs and other measures to help them quit the use of tobacco products.
I acknowledge that I have received a complete description of the Wellness Programs from the Employee Benefits Department of the Company, and that I agree to the terms of the Wellness Programs as described to me therein.
I have received a notice from the Company regarding my rights under the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act. I understand that health information, which may include genetic information about me, such as manifestation of a disease or disorder in me or my family members, may be collected during my participation in the Programs as described in the notice. I understand that this health information will be used to provide me with results and follow-up information to help me understand my current and potential health risks, and in some cases may also be used to offer me services through the Programs.
I understand the Programs will not disclose my health information publicly, to the Company, or to my spouse who is employed at the Company, except as expressly permitted by law. I understand my health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the Programs, and I will not be asked or required to waive the confidentiality of my health information as a condition of participating in the Programs or for my spouse who is employed at the Company to receive a Program incentive. I understand that my health information may not be used by the Company in making an employment decision relating to my spouse, and my spouse will not be discriminated against or subject to retaliation by the Company if I decide not to participate in one or more components of the Programs or because of the health information I provide.