SAN FRANCISCO -- Employers are trying a new tactic to prod their workers to live healthier lives and thus reduce medical costs: more creative and often lucrative incentives.

Despite the effects of the recession, many employers are spending more money on wellness programs that aim to help people eat right, get regular exercise, manage stress and quit smoking.

And they're experimenting with new ways to motivate employees to switch or stick to healthful habits, said LuAnn Heinen, vice president of the National Business Group on Health, a Washington-based group of large employers. "Everyone knows what to do," she said. "It's not a lack of knowledge that's the problem."

Among the incentives: additional time off, prize drawings, workplace competitions, discounts on health-plan premiums or gym memberships, and even cash.

Your health insurance likely has gotten more expensive and less comprehensive in the last decade. But now is a good time to see what your employer may have put on the table to help you improve your health and productivity.

Employers spent an average of $220 per worker on wellness incentive awards last year, up 35 percent from $163 in 2009, according to a survey of more than 1,200 employers from Buck Consultants, a benefits-consulting group based in New York. About 11 percent spent more than $500 per employee last year.

Nearly three out of four North American employers have some sort of wellness program, according to the survey. Many programs include a confidential health screening, where workers can fill out a health-assessment questionnaire or undergo routine tests to alert them to their blood sugar and cholesterol levels. But some programs are branching out in unconventional directions.

Webcor Builders, a general contractor in San Mateo, Calif., recently revamped its wellness program for its 325 salaried workers, said the company's benefits specialist Geraldine Slattery.

"The reason a lot of wellness programs go stale is there are not a lot of incentives for employees to continue. They do their health assessment; it's done," Slattery said. "We wanted something different."

Last March, Webcor signed up with Limeade, a wellness company based in Bellevue, Wash., and started soliciting "challenges" from employees -- ideas for co-workers to meet certain health and fitness-related goals. Starting this year, a new committee will vet ideas that come in.

Challenges target a scope of different activities and behaviors. For example, workers can earn points for getting their routine preventive care done in a timely way, for eating five fruits and vegetables a day, or for climbing the most flights of stairs over a set time period.

Participants can track their points by logging on to the Limeade system from work or home, Slattery said.

Last year, employees who earned the maximum number of points were rewarded with one paid day off, called a "wellness floating holiday." This year, the company is doubling its offer.

Workers who earn a total of 4,000 points get two paid days off. Steady participants also are entered in quarterly drawings for an extra day off and gadgets like Amazon Kindles, Nintendo Wiis and Apple iPads.

The program is flexible enough to adapt to the needs of a diverse employee population, some of whom bike to work and others who are more sedentary, Slattery said. "You need to provide a little bit of everything."

A focus on wellness has helped Florida's Sarasota County government notch a 3 percent drop in the cost of health care premiums this year, said Angela Gustafson, a registered nurse and the county's wellness-development adviser.

Sarasota County, which employs 3,200 people, offers 33 on-site group exercise classes over staggered lunch hours and before and after work, she said. Nearly a third of the classes, including spinning, yoga and Zumba, are taught by qualified worker volunteers.

Workers also can take advantage of four free sessions a year with a personal trainer. That benefit has boosted use of the county's five fitness centers, Gustafson said, but gym-averse employees can tap trainers to start a fitness regimen as simple as walking.

Those who complete their four free sessions also get $25. Workers can earn up to $100 a year by participating in various wellness activities.

Helping workers to better cope with stress is a priority as well. The county has seen lower medical and prescription-drug spending among 911 operators since launching a stress-management program called Heart Math in 2009, she said.

After seeing good results from a program where employees with medical conditions worked with a dietician, the county is changing its health coverage to allow workers to see the dietician for free even if they don't have a specific diagnosis, Gustafson said.

Where Sarasota County takes a hard line is with job applicants who smoke. It won't hire them.

Tobacco use is often where wellness benefits are the richest or most punitive. It's not uncommon for large employers to offer incentives of $250 or more to entice smokers to quit, Heinen said. But a small number tack a surcharge onto tobacco users' health-insurance premiums.

One Webcor employee, 56-year-old Karen Thayer, got hooked on the stair challenge. The result: She lost 50 pounds over six months and was able to stop using one of her blood-pressure medications. She also got an extra day off and won an Apple Touch at a quarterly raffle.

"I never thought I would be able to do the stairs," she said. But she was determined to work through the pain from a knee replacement and other physical hurdles.

Now she can climb 36 flights in 15 minutes. Thayer said she's confident she can lose another 40 pounds. "It definitely came from a behavior change because of the program that I constantly got out there and did it and did it and did it.

"When I started doing the stairs, the strength in my knees came back because it's really important to keep the strength up in the muscle groups around your knees. It's really made a big difference," she said.