The program is voluntary, as are the supplement manufacturer's subsidized Weight Watchers meetings, discounts on off-site gym memberships, free blood screens and "lifestyle coaches" that provide employees encouragement to meet their health goals.

But most of the 550 workers participate because it pays off for them and their company: Nature's health insurance costs are rising less than 2 percent a year - instead of the double-digit jumps other employers have seen - saving the company an estimated $5.5 million since 2003.

And employees like Mason - who credits his work-inspired exercise and diet for helping him weather a bad biking accident - earn up to four hours of paid time off every six months and get free health insurance. Those who don't participate in the health screens and goal-setting must pay 15 percent of the premium.

Expect to see more rewards for healthy behavior - and monetary penalties on the unwilling - as Utah employers turn to wellness programs to help them reduce health care costs and boost employee productivity. According to SelectHealth, the state's largest insurer, premiums across the state are expected to jump an average of 10 to 12 percent in 2009. Now's the time many companies are planning their insurance plans for next year and, in addition to reducing benefits and shifting costs to employees, many are demanding incentive programs from their insurers and accountability from their employees.

Christine Frazier, Nature's insurance benefits manager, said the traditional insurance model of "if I get sick I can go to the doctor and he can fix my problem" has to go, a belief echoed by lawmakers who are trying to reform Utah's health care system.

When national figures show 70 percent of health care pays for preventable conditions, employees should "feel like they do have a responsibility to address some of these issues before they become chronic," she said.

What's legal, what's not: Through the Health Insurance Portability and Accountability Act (HIPAA), the federal government allows employers to vary benefits and premiums based on whether employees have met standards of a wellness program. The new rules apply to group health plans and went into effect last July, though similar draft rules were in effect in 2002. And while they prohibit discrimination, they do allow employers to offer rewards to nonsmokers, employees who have a cholesterol level under 200 or a body mass index below 25, for example.

But to do that, the reward cannot exceed 20 percent of the cost of coverage. And employers must offer alternative standards to employees who, for a medical reason, cannot meet the benchmarks.

For instance, while employers can't tell a diabetic to lose weight or a smoker to quit, they can require the diabetic to participate in nutrition classes and the smoker to track the number of cigarettes he or she smokes each day, said Darrell Moon, CEO of Murray-based Health Behavior Innovations, which works with 30 employers, mostly in Utah. His company assesses employees' health risks and, for the ones that don't meet the company's standards, helps them set and reach goals. Those who hit their targets - whether it's taking their medications, cutting out candy bars or exercising three times a week - get the company's incentive, typically lower premiums. Those who don't pay extra - funding the wellness program for the rest, he said.

To protect employees' privacy, employers know the employees' risk levels and which ones participate in the program, but not their personal health statistics.

Auto dealer Ken Garff, one of Moon's clients, sets its cholesterol, body fat and blood pressure benchmarks high - 60 percent of participants in the wellness plan don't meet them and must work with coaches - along with its incentive: Participants get nearly $500 off of health insurance a year, said Erin Johnston, the auto dealer's benefits administrator. Another benefit: Their cholesterol, blood pressure, body fat, doctor visits and health care claims have dropped.

"We can see these daily baby steps make a difference," said Johnston, whose coach helps her plan more dinners at home.

Employees in other programs report cutting back on fast food, reducing blood pressure without taking drugs and needing to buy smaller clothing sizes. "I can see my shoes more easily now," said one.

Moon, a former hospital administrator, said he started his company because he wanted to stop making money filling up hospitals and make it "by helping people be healthy."

He acknowledged it's a radical shift for employers to design their benefits around prodding the sedentary American into a more active, diet-conscious lifestyle. But he expects it will be the norm within a decade.

"Employers don't know they can do this, [they] can build their strategies around engaging people to be healthy. There's really, anymore, no reason not to."

Resistance and success: But employers have met resistance. Even with money on the table, some employees refuse to participate.

Mark Garvre, a Salt Lake City lawyer who advises employers how to comply with HIPAA, knows of no legal actions in Utah over wellness programs. "It'll become a bigger legal issue to the extent employers become more demanding," he said.

Greg Cox, assistant human resources director at Logan City, said employees were skeptical when they learned they would start paying $25 to $50 more a month for health insurance, starting in July, if they don't participate in SelectHealth's wellness program. Some thought getting their blood pressure, cholesterol, blood sugar level and body fat tested was intrusive. Others said they were too busy to take health classes and work with a coach.

Still, 90 percent signed up. "They know we have to do something," Cox said, adding that he tries to lead by example. "If I have a donut in my hand, I get harassed about it."

Still, some companies aren't willing to ding employees who don't get healthy. Barnes Bank, in Kaysville, is instead counting on the idea that encouraging good health will lessen next year's sticker shock.

Its premiums jumped 24 percent this year, prompting the company to join Regence BlueCross BlueShield of Utah's new small-group wellness plan, which provides case management, 24-hour nurse advice, health risk assessments and coaching. In addition, employees who meet a monthly challenge can enter to win $75. The bank also persuaded its reluctant vending machine supplier to add healthier snacks such as granola and pretzels. And it's urging employees to buy generic drugs and educating them about the proper use of emergency rooms.

"As I walk through the halls," Jenny Nielsen, the bank's wellness coordinator said, "I hear people saying, 'Have you done your exercising today?' "

hmay@sltrib.com