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To quantify the impact of health risks on medical care and productivity costs in an employed population.Health risk, medical care, and productivity data were obtained for 5875 Novartis employees in 2005-2006. Factor analysis was performed to identify relationships among health risks. Multiple regression analyses were applied to estimate relationships between combined risk factors and costs.We found a significant and consistent association among three factors (high biometric laboratory values, cigarette and alcohol use, and poor emotional health) and increased presenteeism for both men and women and increased absenteeism for women. Medical care expenditures were 13-22% higher for men and women at risk for the high biometric laboratory values and the emotional health factor.There is a potential for medical and productivity savings for employers able to reduce health risks among their workers.