"[1] Is it acceptable to design a program where employees who use tobacco may avoid a higher insurance premium (or surcharge) only by quitting tobacco use? No.... [2] Are there any limits to the 'reasonable alternative standard' an employer can require for tobacco users to obtain the reward? Yes.... [3] Is it acceptable to design a program that restricts participation in certain health benefit options to employees who are tobacco-free (i.e., maintain a tobacco-free 'threshold' requirement for participation in certain health plans)? Generally, no.... [4] Does it matter whether an employer characterizes the different treatment of employees who use tobacco (and refuse to complete an alternative standard) and tobacco-free employees as a penalty or a reward? No."