Shifting Risk, Responsibility

"Employers are very interested in this because by making employees healthy, they are also more productive. It's also a more efficient way to pay for health care," said Tracy Watts, a principal with Mercer Human Resource Consulting.

Maryland's Black & Decker provides its employees with up to $300 to spend on such things as exercise equipment, gym memberships or on-site Weight Watchers programs.

Raymond Brusca, vice president of benefits, said health-care costs have been reined in by an aggressive program aimed at making employees responsible for what he calls "health consumerism." Employees are encouraged to take charge of what they eat, how they exercise, and whether they should agree to multiple X-rays and medical tests.

In addition to the $300 fund, employees can get $50 to complete an online health assessment. They may also be assigned a free health coach. Starting next year, workers can get up to an additional $150 for such activities as exercising three times a week, taking part in disease management programs and accessing health information on their insurance carrier's Web site.

For the first time next year, employees will have to pay 20 percent of the cost of the prescriptions. In the past, they had a fixed co-pay. The company hopes once employees see how much their prescriptions cost, they will choose generic drugs. Of Black & Decker's total health-care costs, prescriptions account for 21 percent, Brusca said.

The company is raising rates next year, but employees can get a lower rate if they sign an agreement certifying they do not use tobacco, Brusca said.

A payment for exercising, or for not smoking, may not dramatically offset the rising premiums and higher deductibles, but at least it helps some people feel their company cares. But there is no question people miss the old system that now seems so easy.

"A lot of this is carrot and sticks," Brusca said. "Some would say carrot and club."