Some employers are investing more time and resources to find out whether workers are tobacco-free and in the process are rewarding those who pass muster with lower health premiums or financial rewards.

To combat the high health costs associated with smoking-related diseases, employers historically have relied on implementing smoking cessation programs and instituting tobacco-free worksites and campuses. For a few, efforts now extend to firing and not hiring workers who use tobacco products.

But for the most part, companies are simply requiring workers who use tobacco products to put more money toward health premiums or excluding them from financial rewards tied to tobacco status.

"Employers typically use a voluntary system in which an employee signs an affidavit stating he or she is tobacco-free. By not signing and returning the affidavit, the worker by default is saying he or she is a tobacco user," says LuAnn Heinen, vice president of the National Business Group on Health and director of its institute on innovation in workforce well-being.

On your honor

Companies with a tobacco surcharge allow workers to obtain the tobacco-free premium if an employee makes an attempt to quit by enrolling in the company's smoking cessation program. Employers typically notify workers one year in advance on the decision to institute tobacco-based health premiums.

The heads-up approach allows employers some leeway to promote and expand smoking cessation benefits. And for employees who use tobacco products, the extra year affords them the opportunity to quit the habit before facing a tobacco surcharge.

Once a surcharge takes effect, some employers will ask workers to sign off on either a covenant or an affidavit stating they are a nontobacco-user and will not use tobacco products for the next 12 months. In some cases, the language in the agreements states the terms are subject to verification.

"It's actually surprising how honest people are in disclosing their tobacco-use status to employers," says Seth Serxner, a partner at Mercer. He recites a telling story in which an employer told him that several employees who enrolled in the company's smoking cessation program had signed an affidavit saying for the next 12 months they will be tobacco-free.

"Then a couple of months into the program, they started smoking again. The employees called the benefits department to say, 'Hey, look, I am smoking again, so add the surcharge,'" says Serxner. "Frankly, employers don't want to get into a policing role." He estimates that about 20% of workers are not forthcoming about their tobacco use when formally asked by their employer.

Keeping them honest

However, some employers, especially those who base health insurance premiums on tobacco use, are implementing tobacco-use testing to evaluate compliance. When an employer uses a biometric screening to test for nicotine, they normally do so through a saliva cotinine test.

Some experts note, however, that cotinine levels drop pretty quickly when a person stops using tobacco, so a person can stop using tobacco for a couple of weeks before the test and pass it.

Because of the cost of cotinine testing and the limits associated with its effectiveness, companies still are more like to rely on the self-reporting that occurs through a health risk assessment to find out whether workers are using tobacco, says Eric Zimmerman, chief marketing office of RedBrick, a Minneapolis-based firm that runs wellness and disease management programs for employers."If you get into the economics of biometric screening for tobacco use, it's not a cost-effective approach, considering the cost of testing on a broad-based population," says Zimmerman.

Still, it may be worth it to employers to add a testing element to their smoking cessation efforts. Notes Heinen, as incentives around tobacco usage become larger, "ensuring workers are tobacco-free is a fight worth fighting, because in the end, it's good for both the employee and employer."

Strong employee communication on premium differentials around tobacco status is key, Janna Lacatell, senior account executive and business development at Healthways, Inc.

Communicate your reasons

Employers should focus on communicating to workers the reasons why the organization decided to institute a tobacco surcharge or cotinine testing. That way, employees will fully understand what is happening, and they can start to mentally prepare themselves for the change.

Some "might decide to make a quit attempt as a way to prepare, while others may decide they are not ready at this point to make a change," says Lacatell.

Meridian Health offers a robust smoking cessation program to help team members move away from tobacco use. Most of the program's benefits kicked in, in 2007 as the company prepared to become a smoke-free organization in November 2008.

"We created a number of ways to support team members to quit the habit," says Kathleen Boushie, director of human resources at Meridian Health, a hospital chain in New Jersey.

The smoking cessation program is an online-telephonic support program in which members can fill smoking cessation prescriptions and refill over-the-counter nicotine replacement items though an onsite ambulatory pharmacy.

Those services are provided to team members for free. So far, more than 320 team members have taken advantage of the benefit, Boushie recounts.

As a health care provider, Meridian can tap into its own resources to help its workers quit smoking and using tobacco products. "We have certified tobacco-treatment specialists to help the community, but our team members can take advantage of those services without any costs for monthly support sessions," Boushie adds.

This year, the company added a tobacco-use question to its it health risk assessment. In addition, results from biometric screenings, including a nontobacco-use status, can earn team members health incentive credit to reduce their health premium costs. The company's biometric screening process also includes a saliva cotinine test, which is voluntary.

Affinia Group, Inc., an Illinois-based company that produces highway replacement products, has, since 2005, offered a smoking cessation program that covers 30-day nicotine therapy replacement and a telephone-based health coach provided by its wellness vendor.

Under the company's CDHP, workers who prove they are tobacco-free by passing a saliva test for nicotine can receive a $100 contribution to their health reimbursement account.

The company, which employs about 3,000 workers, announced the policy in 2010, and the credit will take effect in 2012, explains says Bob Soroosh, director of benefit administration at Affinia.

Of the 400 employers at the company's South Carolina worksite who participated in recent onsite health screenings, 300 took the saliva testing for cotinine.

He recommends that employers stay focused on offering smoking cessation benefits and consider incentives that are "most appropriate within the context of their health and welfare plans."

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