Knowledge and perceptions among overweight and obese employees about lifestyle-related health benefit changes.

183 B risk factors such as smoking and obesity are associated with an increase in many preventable chronic diseases that affect the health of working adults, as well as influence the financial health of employers. For example, obesity is estimated to cost employers $73.1 billion annually [1], and tobacco use is estimated to cost employers $75.5 billion annually [2], both in direct medical costs. As health care premiums rise, employers are increasingly looking for ways to maintain or reduce costs [3-7]. According to a nationally representative survey of employers conducted in 2009, 21% of respondents reported that, in response to the economic downturn, they reduced the scope of health benefits or increased cost sharing [8]. From the perspective of employers, imposing health insurance surcharges or limiting benefits for employees with risk factors, such as smoking and obesity, associated with leading chronic diseases may be more desirable actions than other forms of cost shifting [3]. Although these surcharges are an additional financial burden to high-risk employees, one possible benefit is that the surcharges may increase motivation in these individuals to quit smoking or to lose weight. However, little is known about employee perceptions about such changes before they are implemented, whether employees are motivated to consider making a behavioral change, and whether employees are confident in their ability to make desired behavioral changes. Consequently, data-driven guidance is lacking for individuals who are constructing health benefit changes. During 2010 in North Carolina, approximately 661,000 state employees had health insurance as a benefit covered by the State Health Plan for Teachers and State Employees. In April 2009, North Carolina Senate Bill 287 became law, and the Comprehensive Wellness Initiative went into effect [9]. For years, employees were automatically enrolled in an 80/20 health benefit plan, in which 80% of health care costs are covered and 20% are paid by the employee. Beginning in July 2010, all state employees were automatically enrolled in a 70/30 health benefit plan, in which 70% of health care costs are covered and 30% are paid by the employee. The official health benefit policy can be accessed on the State Health Plan Web site (available at: http://www.shpnc.org/ Knowledge and Perceptions Among Overweight and Obese Employees About Lifestyle-Related Health Benefit Changes