The objective of this publication is to provide guidance regarding appropriate use of outcomes-based incentives as part of a reasonably designed wellness program designed to improve health and lower cost while protecting employees from discrimination and unaffordable coverage.  The process to produce this publication included reviewing the literature, regulations, case studies, and other resources while developing consensus through numerous group discussions. The authors offer guidance on the elements of a reasonably designed wellness program that should be in place if outcomes-based incentives are deployed and identify strategies to help ensure that effective and fair programs are put in place and evaluated. The authors strongly encourage employers using outcomes-based incentives as part of wellness initiatives to incorporate these elements of a reasonably designed wellness program and consider this guidance for the design, implementation, and evaluation of such programs. Published: 2012