Obese? You may pay more for insurance

This post comes from Jen Wieczner at partner site MarketWatch.

Here's something employees don't usually expect when they attend orientation for a new job: weigh-ins and waistline measurements.

But as companies struggle to curb rising health care costs, they are increasingly pointing a finger at workers' ballooning bellies. Obesity-related health problems account for a big chunk of medical claims, insurance experts say, leading some executives to believe the best way to trim their budgets is to get workers to trim their own fat first.

"There's a lot of concern around how obesity should be dealt with in the corporate setting," says Michael Wood, a senior health management consultant at human resources firm Towers Watson.

For the past few years, companies have experimented with tying health insurance premiums to people's health. Here's how it works: Employees go through medical and biometric testing as part of their health insurance open-enrollment process. They are weighed, their height and blood pressure are measured, and their blood is drawn. Those with high scores on cholesterol, glucose and blood pressure -- or with chronic conditions like diabetes -- are told they will have to pay higher premiums unless they actively try to address any risky conditions.

The premiums can also be tied directly to one's body mass index (those with scores over 25 are rated overweight; 30 and above is considered obese). Some companies hike rates even for those with a BMI as low as 27, Wood says. An online tool on HealthInsurancePlus.​com, for one, allows consumers to estimate their BMI and premiums by plugging in their height and weight. Expect to see a 25% increase in premiums for BMI scores greater than 30 or 31 in major health insurers' plans; someone with a BMI over 39 might pay 50% more a month, according to the site.

A separate report by eHealthInsurance, an online health plan marketplace, found that individual insurance policyholders in the obese category paid 22% more in monthly premiums, on average, compared with those with "healthy" weight (obese men paid 29% more).

But since body mass index is the rough equivalent of a fat score, some critics say forcing employees to pay fees for being fat is too personal and unfair. While companies are legally allowed to raise premiums on employees who are obese or have other chronic conditions only if they provide a way to duck the charge through treatment or participation in Weight Watchers or disease management programs, some employers are being more strict -- requiring employees to shave off BMI points by dropping pounds before they'll waive the surcharges, says Wood.

Some are ignoring the law altogether and simply sticking employees who have unfavorable health scores with higher premiums. "The return on healthier folks is worth the risk of somebody trying to sue them for discrimination," Wood says.

To be sure, a few extra pounds isn't necessarily a bad thing. A new study of BMI and mortality by the U.S. Centers for Disease Control and Prevention found that individuals rated overweight, with a BMI of 25 to 30, had a 6% lower risk of death than those in the "healthy" category. But individuals considered obese, with a BMI of 30 or above, had an 18% higher death risk -- and becomes greater as weight increases.

Making smokers pay extra is more widely accepted than penalizing workers for relative fatness, says Wood -- and perhaps with good reason. Smokers have a higher success rate with quitting than obese people have with getting back to normal weight. Plus, he adds, smoking seems more like a choice than being heavy. "You don't have to smoke to live; you have to eat to live," Wood says.

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