"Employers that did not use incentives reported lower participation rates -- a median of just 20 percent. Uptake appears to increase with the use of rewards, such as access to a higher-value health plan, with a median participation rate of 40 percent. Framing incentives as penalties, such as higher insurance contributions for smokers, was associated with an even higher median participation rate of 73 percent. Program configuration also influenced participation. Employers with comprehensive programs reported the highest participation rate, at 59 percent. Participation in these programs was less sensitive to choice of incentive scheme."