The remarkably punitive wellness provisions  developed by the North Carolina State Health Plan and authorized by the General Assembly are uniquely invasive.
Indiana provides a premium discount to non-smokers and reserves the right to conduct random cheek swabs, but no other health plan uses our state’s strange combination of severe punishment for smoking and obesity combined with regular, random testing. South Dakota reserves the right to verify smoking status but seems to test for tobacco use only when it has cause (i.e., someone snitches on a fellow employee).
Nearly every state that uses smoking surcharges or premium discounts rely on the honor system including Georgia, Alabama, Tennessee, Kentucky, Kansas, Missouri, and South Carolina.
In West Virginia you can give the health plan access to your medical records so it can check for signs of smoking. I can’t imagine it’s practical for the plan to actually look through medical records, although it could pull a sample every now and again.
So North Carolina is really pioneering in its distrust of public employees.