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Companies have long promoted healthier behavior by subsidizing gym memberships and smoking-cessation classes. But several private and public employers have started tying financial incentives to their health-insurance plans. North Carolina this year became the second state to approve an increase in out-of-pocket expenses for state workers who smoke and don't try to quit or who are morbidly obese and don't try to lose weight. Alabama was the first to pass what critics call a fat fee, in 2008, and several state insurance plans have started imposing a $25 monthly surcharge on smokers...
...there's a big difference between handing out gift cards and jacking up people's co-pays. The Tar Heel State in particular has been criticized for using a big-stick approach. Starting in July, state workers who smoke will be moved from the plan that covers 80% of health care costs to one that pays 70%, an out-of-pocket difference of approximately $480 a year, unless they agree to enroll in a smoking-cessation program...
...state will turn its attention to the obese. Workers who have a body mass index (BMI) below 40--e.g., someone who is 5 ft. 6 in. and weighs 250 lb.--can remain in the 80% plan for the first year. But after that, they need to either have a BMI of 35 (5 ft. 6 in., 217 lb.) or enroll in a weight-loss program to qualify for the less expensive plan...
Alabama, rather than adopting penalties, is offering discounts on state workers' $70 monthly premiums. To get $30 off for not using tobacco, participants have to sign a form under penalty of perjury. (An audit of relevant medical records could result in back-billing and a recall of claims.) Since the plan started giving such a discount in 2005, it has seen a 4% decline in the number of smokers...
After Dec. 31, state employees in Alabama will be eligible for an additional $25 discount on their monthly premiums if screenings indicate that their blood pressure, blood glucose, cholesterol and weight are in the normal range or if they see a doctor to address any risk factors. People with a BMI of 35 or higher have to enroll in a weight-loss program to receive the discount...