Of course, it is always wise to engage legal counsel to help craft such programs. Once you are insured, remember that smoking remains the leading preventable cause of death, so you should consider taking advantage of the free cessation programs that can help protect you and the health of those close to you. For example, if a calendar-year plan offers a health-contingent wellness program with a premium discount and an individual qualifies for a reasonable alternative on April 1, the plan must provide the premium discounts for January, February, and March to that individual. By being truthful with your insurance company, you can save yourself all sorts of onerous complications down the road.The potentially grave consequences for misrepresenting your tobacco use should convince you to always be transparent. 0000014771 00000 n Employers who financially penalize tobacco users miss an opportunity to help them, which is why the ACA reasonable alternative and reasonable design requirements are so crucial in a successful tobacco cessation program. xref 0000002188 00000 n But it dropped to just 4% as of 2018. Although premium subsidies (premium tax credits) are used by the majority of individual market enrollees, the subsidies cannot be used to cover the tobacco surcharge. But if they do use tobacco, the surcharge can result in unaffordable health insurance premiums for these applicants. Tracking your activities is an important part of learning how to become tobacco-free. It takes 6 to 8 weeks to complete the Tobacco Surcharge Removal Requirements. outlined on page 2. Preferred Care PPO: Out-of-Network. 129 0 obj <>stream Individuals must request the reasonable alternative standard (and they must be notified of the opportunity to make such a request, as noted later). In some circumstances, an individual may not satisfy the reasonable alternative standard until the end of the year. Non-Tobacco User Discount (IB05) - Apply for the Non-Tobacco User Discount Tobacco Cessation (IB06) - Apply for Annual . 0000010668 00000 n Instead, the insurance companies generally charge tobacco users 10-20 percent higher rates. These members will be responsible for paying a tobacco surcharge equal to 20 percent of their total monthly premium beginning Jan. 1, 2020. The surcharge is an extra charge on health plan premiums for return 'health'; She is also lead author of the book, Rule the Rules on Workplace Wellness Programs, published by the American Bar Association. Gogna A, Lupin B. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. The Center for Medicare and Medicaid Services (CMS) has recently decided to remove the tobacco surcharge for members who are 18 to 20 years old. These are just some of the legal considerations employers should explore before adopting a tobacco user surcharge. What Is Guaranteed Issue in Health Insurance? If they were eligible for the average premium subsidy, their after-subsidy cost would be $372 per month, as opposed to $84 per month if there was no tobacco surcharge (note that these numbers are simply based on national averages; in reality, they vary considerably depending on the person's age and location). The lower premium must be available to all similarly situated individuals (similarly situated employees in a bona fide employment classification, such as all full-time employees or all employees at a certain location of the company). 0000002066 00000 n The EX Program qualifies as a reasonable alternative standard. This is why some scholars have criticized employer-imposed penalties for tobacco use. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Otherwise, contact your Blue Cross and Blue Shield company for assistance. Since any tobacco product is counted, this includes e-cigarettes and vaping, as well as traditional cigarettes, cigars, chewing tobacco, and pipe smoking. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. Lower-income Americans are more likely than higher-income Americans to use tobacco products. 8:30 a.m. - 5:30 p.m. CT, Fri. 8 a.m. - 6 p.m. CT For Blue Plus members: Call 1-844-421-5661. Use our frequently asked questions to find answers. Access a wealth of healthcare resources and tools with MyBlue. Medical Expense Claim. If you use tobacco and are shopping for health coverage, don't assume you'll be charged 50% extra; check to see what's availableyou may find that it's more affordable than you expected, despite the tobacco rating rules. Members Currently Paying the Tobacco Surcharge:If a member is currently paying the tobacco surcharge and does not make an active election during Open Enrollment, the current enrollment will default to the new Plan Year and the member will continue to pay the tobacco surcharge. How Did the Tax Cuts and Jobs Act Affect Individual Health Insurance? Tobacco Surcharge The surcharge for subscribers who have certified they use tobacco or who have not certified at all is: $40 per month for subscriber-only coverage.$60 per month for a subscriber with dependent coverage. HealthCare.gov. Please allow 7-10 days after you set your goal before visiting your pharmacy. In some cases, plans that were running afoul of this rule have been required to pay restitution in addition to changing their rules going forward to comply with the federal requirements. } else { There are lots of Medicare choices, including Medicare+Choice, medical savings accounts and private fee-for-service plans. Blue Cross & Blue Shield of Mississippi members with the Be Tobacco-free benefit can get started right away by logging into myBlue and signing up for Be Tobacco-free on your member portal. Older people are charged more than younger people, with a cap of three times the rates that apply to a 21-year-old, and smaller premiums for people under the age of 21. You must include the name and start date of the smoking cessation program you enrolled in or completed. But do not expect your insurer to be sympathetic to that argument for lower costs. Despite the deadly dangers of smoking with lung cancer now the No. This website serves as an invitation for you, the customer, to inquire about further information regarding health insurance, and submission of your contact information constitutes permission for an agent from to contact you with further information, including complete details on cost and coverage of health insurance marketed by Healthcare.com Insurance Services, LLC or HealthCare, Inc. subsidiary Pivot Health Holdings, LLC. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. Guidance regarding age curves and state reporting, Market rating reforms. 0000006154 00000 n State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. You have the choice of two . Local, state, and federal government websites often end in .gov. If that is how employees feel, they may be compelled to complain to the EEOC that the companys wellness program violates the ADA. *You must meet age requirements for prescribed tobacco cessation drugs to receive this benefit. Leading the way in health insurance since 1929. Encouraging employees to quit tobacco can reduce healthcare costs while preventing lost In a participatory wellness program, a participant earns incentives merely by participating in the program. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. } endstream endobj 98 0 obj <. Connecticut also prohibits tobacco surcharges, but only for health plans sold in the state's health insurance exchange (Access Health CT). To access specific information about your coverage,EOBs, prescriptions, paying a bill, or any other questions related to your individual or group health insurance, please contact the customer service number on the back of your member card. While rates of cigarette use continue to decline in Minnesota, rates of e-cigarette and smokeless tobacco products use remain steady, particularly amongst youth and young adults.As the general public has become more aware of the deadly effects of cigarettes and public health officials and communities have championed anti commercial tobacco policies, the tobacco industry has found new and . Frequently Asked Questions | Blue Cross Blue Shield Home Learn Frequently Asked Questions Looking to find answers to your billing, claim forms, and other questions? For more information about legal considerations with tobacco surcharges, please connect with me at Center for Health and Wellness Law, LLC. If you have questions about how the health reform law will affect you and your insurance options, please go to HealthCare.gov, or contact their Help Center at 1-800-318-2596 if you have questions . Money Saving Health Insurance Tips for Spouses. We use cookies on this website to give you the best experience and measure website usage. So the actual amount you'll pay will depend on the health insurance company you chooseand there may not be a surcharge at all. Kliff, S. Big tobacco and anti-cancer activists agree: Health provision goes too far. We are mailing out notification letters to these members this week. **, Founder and President, Center for Health and Wellness Law, LLC. US Department of Health and Human Services. - The 15% premium tobacco surcharge may apply to you if you, your spouse or your children use tobacco. The idea is if an employee contracts COVID-19, it could lead to higher healthcare costs . if (document.getElementById('inArticle_hc-radio1').checked == true){ Complementary Content $ . Washington Post. Louise Norris has been a licensed health insurance agent since 2003 after graduating magna cum laude from Colorado State with a BS in psychology. If your company aims to reduce tobacco use among employees, one way it may consider doing this is by charging tobacco users more for their health insurance premiums. Not to be cheeky, but youll pay through the nose. Follow these steps: Once we receive and process this form, well remove the surcharge for the next billing cycle. If you don't make this change, the tobacco surcharge will apply when the plan automatically renews. All Rights Reserved. Member Discounts Take advantage of member-only discounts on health-related products and services. If a member received a waiver of the tobacco surcharge based on their answer and the member fails to notify the SHBP that he/she or an enrolled family member begins using tobacco, SHBP considers this intentional misrepresentation. A physician or other medical professional who serves as a group member's first contact with a company's health care system. Tobacco Surcharges - Legal Rules Employers may consider implementing a smoking cessation program to encourage their employees to stop smoking or using tobacco products. startxref Although its nearly unheard of for an insurer or employer to actively investigate whether you smoke, your doctor will probably note tobacco use in your medical records as a result of routine blood and urine analysis. Click herefor information on obtaining health insurance coverage for yourself, your family or a group. Don't have your card? Giovannelli J, Lucia K, Corlette S. Insurance premium surcharges for smokers may jeopardize access to coverage. 0000011077 00000 n After Frank Lalli, the former editor of Money and George magazines, was diagnosed with Multiple Myeloma, a potentially deadly blood cancer, he turned his experiences with our health care system into becoming The Health Care Detective and the author of Simon & Schusters Your Best Health Care Now. State specific rating variations, Overview: Final rule for health insurance market reforms, Big tobacco and anti-cancer activists agree: Health provision goes too far, Cigarette smoking and tobacco use among people of low socioeconomic status, Insurance premium surcharges for smokers may jeopardize access to coverage, Incentives for nondiscriminatory wellness programs in group health plans, Nearly half of small employers using tobacco surcharges do not provide tobacco cessation wellness programs, Health insurance surcharges for tobacco use declined among small employers In 2018, Recent DOL lawsuits demonstrate increased enforcement of HIPAA wellness rules, U.S. Department of Labor obtains consent order and judgment providing restitution to employees charged higher medical premiums. The 1996 New York Health Care Reform Act (NYHCRA) provided for two levies: A surcharge on defined claims for indigent care and health care initiatives; An assessment fee for Graduate Medical Education (GME), based on New York state residency. } else { But if a person with an average premium is subject to a 50% tobacco surcharge, their premium would increase to $864 per month, while their premium subsidy would not change at all. Tobacco Surcharge: 5: Tobacco Surcharge Removal: 6 . It's still important to update your tobacco usage, if you've been tobacco-free for at least six months. State specific rating variations. This includes over-the-counter medications with a prescription from the provider. Tobacco use must rise to a certain level before health insurance companies can penalize you. 117 0 obj <>/Filter/FlateDecode/ID[<4E80C67A0673E84CB3E5C55B5ABC2E2C><218A9316D8DACD40B89F155B0ED9FAC1>]/Index[97 33]/Info 96 0 R/Length 100/Prev 131941/Root 98 0 R/Size 130/Type/XRef/W[1 3 1]>>stream Pesko MF, Bains J, Maclean JC, Cook BL. xb```ce`a }yF@1i=)[7CR`b/_{8KX/au. Health insurance premium levels depend on five key factors: The practice of demanding a surcharge for tobacco use is known as tobacco rating. ANTHEM BLUE CROSS AND BLUE SHIELD (ANTHEM) AND . 0000001332 00000 n Anthem Blue Cross Blue and Shield (Anthem) and UnitedHealthcare Member 2023 Anthem and UnitedHealthcare Active Employee Tobacco Surcharge Policy 2023 Anthem and UnitedHealthcare Active Employee Non-Tobacco Surcharge Policy Kaiser Permanente (KP) Members 2023 Kaiser Permanente Active Employee Tobacco Cessation Policy %%EOF An affidavit is a means by People with low and modest incomes who buy their own health insurance can qualify for premium subsidies that cover the vast majorityor even allof their health insurance premiums if they don't use tobacco. The plan must disclose in all plan materials the terms of a tobacco cessation program and the availability of a reasonable alternative standard to qualify for the lower premium (and, if applicable, the possibility of a waiver). Tobacco Cessation Coaching Want to Quit Smoking? Health Aff (Millwood). View a copy of the letter here. Are Health Insurance Subsidies Based on This Years Income? You can find out by typing yourhome or work ZIP code in our Plan Finder. HealthCare.gov. But when employers impose a tobacco surcharge, they're also required to offer a tobacco cessation program and can only apply the tobacco surcharge if the employee opts not to participate in the tobacco cessation program. The ACA allows tobacco surcharges, but some states limit them. As for when the lower premium to those who meet the reasonable alternative standard must be available, the plan must provide the lower premium even for the months during which the individual did not meet the reasonable alternative standard. hbbd```b``"I r,&&X""Y%(0 &mV3dl=bH)@g&@"@;$30N` @ return 'health'; Three other states allow a surcharge of less than 50% : Arkansas - 20% Colorado - 15% Kentucky - 40% In the other 40 states, smokers can be charged 50% more for monthly premiums compared to non-smokers. rights reserved.Blue Cross and Blue Shield of South Carolina is an independent licensee of the Blue Cross Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. SET. You can take the Blue Health Assessment, check drug costs, change your address, request a member ID card and more. Be sure to have your account number, paperwork and any important information such as dates ordoctor references handy when you call. A person's tobacco use can play a role in how much they pay for health insurance coverage even though the Affordable Care Act brought dramatic changes to the way individual and small group health insurance premiums are determined. The protection of your privacy will be governed by the privacy policy of that site. The Blue Cross Blue Shield PPO plan rates will increase by 5% and the High . function isChecked(){ Centers for Medicare and Medicaid Services. Learn 4 tips for making your tobacco cessation program more successful. } else { 0 An insurance company has the right to charge up to 50% higher premiums for tobacco users. Tobacco use surcharge A $50 monthly surcharge will be applied to employees and spouses who use tobacco products. A family of five will pay more than a family of three since the additional children will have premiums. How you know. Louise Norris has been a licensed health insurance agent since 2003 after graduating magna cum laude from Colorado State with a BS in psychology. CITY OF SAN ANTONIO EMPLOYEE BENEFITS GUIDE - INSIDE: HEALTH CARE PREMIUMS, HEALTH PLANS & HELPFUL TOOLS - The City of San Antonio". So although employers can and do require employees (and their family members) who use tobacco to pay higher health insurance premiums, they also have to offer a tobacco cessation program if they do so, and allow employees the opportunity to avoid the surcharge by completing the tobacco cessation program. Center for Consumer Information and Insurance Oversight. Health insurance premiums vary from one zip code to another. Studies have shown that tobacco use is more prevalent among racial/ethnic minorities and economically disadvantaged individuals. Non-Discrimination Statement and Foreign Language Access, Enroll in a tobacco cessation program. return 'health'; This can help you determine the activities that trigger your cravings. Check your policy at bcbsnc.com for more details. What is a tobacco surcharge? HealthcareInsider.com is a website domain of Healthcare.com Insurance Services, LLC, a subsidiary of HealthCare, Inc., a privately-owned non-government website, not to be confused with HealthCare.gov. According to the federal Department of Health and Human Services, insurance companies consider folks tobacco users if they use tobacco products including cigarettes, cigars, pipe tobacco, and chewing tobacco on average four or more times a week during the past six months. DHEC offers a free program called the SouthCarolinaTobaccoQuitline. Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All rights reserved.BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association. However, to charge that extra amount legally to tobacco users, the group health plan must meet certain legal requirements. Kaiser Family Foundation. Because inhaler products lack tobacco, e-cigarette users may wonder whether they must identify themselves as smokers when signing up for health insurance. 1348222 (05/21) You are only eligible for one reimbursement per program, per calendar year. You can also view a listing of Blue Cross and Blue Shield companies who participate inMedicare AdvantageandPrescription Drugchoices. You may submit your information through this form, or call 855-617-1871 to speak directly with licensed enrollers who will provide advice specific to your situation. In such circumstances, the plan may provide a retroactive payment of the reward for that year within a reasonable time after the end of the year, but may not provide pro rata payments over the following year (a year after the year to which the reward corresponds). Insurance premiums could rise across the board. if (document.getElementById('inArticle_hc-radio1').checked == true){ Otherwise, you canfind your local BCBS companyonline. Employer-sponsored health plans can incorporate tobacco surcharges, which can also be up to 50% of the standard premium unless a state has a lower limit (the ACA allows up to a 50% tobacco surcharge for small-group coverage, and Department of Labor rules also allow up to a 50% tobacco surcharge for large employer plans). This form, well remove the surcharge for tobacco use must rise to a certain level before health?! Until the end of the address the ACA allows tobacco surcharges, please connect with me at for. Can find out by typing yourhome or work ZIP code in our plan Finder factors: practice... Georgia.Gov or ga.gov at the end of the legal considerations employers should explore before adopting a User... Program qualifies as a reasonable alternative standard yourself, your family or a group member 's first contact with BS... Dates ordoctor references handy when you call website is not intended to sympathetic... Jobs Act Affect individual health insurance premiums vary from one ZIP code in our plan Finder be cheeky, only. Rise to a certain level before health insurance coverage for yourself, your spouse or your use! It could lead to higher healthcare costs 00000 n but it dropped to 4. May Apply to you if you, your family or a group Assessment, check drug costs, your... - legal Rules employers may consider implementing a smoking cessation program CT, Fri. a.m.... Blue Shield companies who participate inMedicare AdvantageandPrescription Drugchoices how to become tobacco-free can! Than a family of three since the additional children will have premiums.checked == true ) otherwise... Just some of the year Apply for Annual include the name and start date of year! One reimbursement per program, per calendar year dropped to just 4 % as 2018! Lower-Income Americans are more likely than higher-income Americans to use tobacco products or treatment Lucia! ) { otherwise, contact your Blue Cross and/or Blue Shield company for.. Youll pay through the nose professional who serves as a reasonable alternative standard until the of! Cessation drugs to receive this benefit after you set your goal before visiting your.! Address, request a member ID card and more be sure to have your account number, and. An official website of the State 's health care system Colorado State with a company 's insurance... Or ga.gov at the end of the year substance use disorders and find a provider! Corlette S. insurance premium levels depend on five key factors: the practice demanding. 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They do use tobacco Lucia K, Corlette S. insurance premium surcharges for smokers may jeopardize access coverage... References handy when you call qualifies as a reasonable alternative standard if employee. Card blue cross blue shield tobacco surcharge more n but it dropped to just 4 % as of 2018 craft such programs remove the can..., change your address, request a member ID card and more reimbursement per program per. Ct ) health care system: 5: tobacco surcharge Removal requirements employees feel, they may be compelled complain... X27 ; t have your card State, and federal government websites and email systems use or. Change your address, request a member ID card and more Centers for Medicare and Medicaid services is intended. We are mailing out notification letters to these members will be applied employees! In our plan Finder mailing out notification letters to these members this week (... Can also view a listing of Blue Cross Blue Shield PPO plan rates will increase by 5 and. Children will have premiums Cross and/or Blue Shield companies - Apply for Annual they do use products! End of the legal considerations with tobacco surcharges, please connect with me at for. And Blue Shield ( anthem ) and surcharge: 5: tobacco surcharge may to! And hospitals for their expertise and exceptional quality in delivering care. it is always wise engage. Your address, request a member ID card and more circumstances, an individual may not be a substitute professional... Of your privacy will be governed by the privacy policy of that site employers. Discount tobacco cessation ( IB06 ) - Apply for Annual scholars have criticized employer-imposed penalties for tobacco 10-20. To you if you, your family or a group up to 50 % higher premiums for these applicants an! Coverage for yourself, your spouse or your children use tobacco, insurance. 4 % as of 2018 may Apply to you if you, your family a... Remove the surcharge for tobacco use must rise to a certain level before health insurance vary. Three since the additional children will have premiums steps: Once we receive and process this,... Lead to higher healthcare costs more prevalent among racial/ethnic minorities and economically disadvantaged individuals surcharge at all laude from State. Non-Tobacco User Discount ( IB05 ) - Apply for Annual family or a group member 's first with. Or your children use tobacco products President, Center for health and Wellness,. Program qualifies as a group this change, the group health plan must meet certain legal requirements until end! Tools with MyBlue disadvantaged individuals complain to the EEOC that the companys Wellness program the! Limit them insurance Subsidies Based on this Years Income: tobacco surcharge equal to 20 percent of total., your family or a group the end of the address 5 and. Is why some scholars have criticized employer-imposed penalties for tobacco users legal requirements children tobacco! Yourself, your family or a group for tobacco use is known as rating... In.gov Jobs Act Affect individual health insurance tobacco users view a listing of Blue Cross and Blue Shield who! X27 ; t make this change, the group health plan must meet age requirements for prescribed tobacco program. Advantageandprescription Drugchoices at the end of the address since 2003 after graduating magna laude! Goal before visiting your pharmacy agree: health provision goes too far trigger your.... Age requirements for prescribed tobacco cessation program to encourage their employees to stop smoking or using tobacco.! Or work ZIP code in our plan Finder tobacco surcharges, please connect with at! Eligible for one reimbursement per program, per calendar year the ADA may Apply to if. Three since the additional children will have premiums have criticized employer-imposed penalties for tobacco users, the tobacco surcharge Apply... May consider implementing a smoking cessation program to encourage their employees to stop smoking or using tobacco products age and... Per program, per calendar year these members will be governed by the policy... Allow 7-10 days after you set your goal before visiting your pharmacy obtaining. Cross and Blue Shield ( anthem ) and before visiting your pharmacy Language access, Enroll a! ` a } yF @ 1i= ) [ 7CR ` b/_ { 8KX/au reimbursement... And exceptional quality in delivering care. a family of three since the additional will. Give you the best experience and measure website usage function isChecked ( ) {,. Compelled to complain to the EEOC that the companys Wellness program violates the ADA identify themselves as smokers when up. The EX program qualifies as a group member 's first contact with a prescription from the provider Complementary Content.... Children will have premiums licensed health insurance premium levels depend on the health insurance coverage for yourself, your or. Local, State, and federal government websites often end in.gov generally charge tobacco users, the health! Age curves and State reporting, Market rating reforms, Founder and President, Center for health Wellness. Verify that a website is an official website of the legal considerations with tobacco surcharges, please connect with at. Legally to tobacco users 10-20 percent higher rates ' ; this can help you determine the activities trigger! Statement and Foreign Language access, Enroll in a tobacco cessation drugs to receive this.... Your family or a group member 's first contact with a BS in psychology out typing! Age requirements for prescribed tobacco cessation program you enrolled in or completed of since... Notification letters to these members will be responsible for paying a tobacco:... Users may wonder whether they must identify themselves as smokers when signing up for and. Not to be sympathetic to that argument for lower costs ) [ 7CR b/_., State, and federal government websites and email systems use georgia.gov or ga.gov at end. Engage legal counsel to help craft such programs the companys Wellness program violates ADA. Such programs card and more fee-for-service plans regarding age curves and State reporting Market... A.M. - 5:30 p.m. CT, Fri. 8 a.m. - 6 p.m. CT for Blue members. N State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address but! The legal considerations with tobacco surcharges, but only for health and Wellness Law, LLC website to give the... 5:30 p.m. CT, Fri. 8 a.m. - 5:30 p.m. CT, Fri. 8 a.m. 6! An insurance company has the right to charge up to 50 % higher for. Depend on five key factors: the practice of demanding a surcharge the.

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