Tools and resources to help you quit tobacco. All tobacco users may have their tobacco surcharge removed by completing the wellness requirements outlined in the applicable Tobacco Surcharge Removal Policy below. Be sure to have your account number, paperwork and any important information such as dates ordoctor references handy when you call. Verywell Health content is rigorously reviewed by a team of qualified and experienced fact checkers. Otherwise, contact your Blue Cross and Blue Shield company for assistance. Blue Shield Association. HealthCare.gov. 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. Overview Tobacco Cessation Incentive Program Tobacco Cessation Incentive Program If you're ready to quit smoking or vaping or using tobacco, we can help you every step of the way. To access specific information about your coverage and claims related to your individual or group health insurance, please contact the customer service number on the back of your member card. These products dont use tobacco; however, they contain other harmful substances, including addictive nicotine. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association. Studies have shown that tobacco use is more prevalent among racial/ethnic minorities and economically disadvantaged individuals. 2018 Mar;37(3):473-481. doi:10.1377/hlthaff.2017.1062, Bains J, Pesko MF, Maclean JC, Cook BL. But it dropped to just 4% as of 2018. Kliff, S. Big tobacco and anti-cancer activists agree: Health provision goes too far. Click herefor information on obtaining health insurance coverage for yourself, your family or a group. However, if the tobacco cessation program includes a biometric screen or other medical exam that tests for the presence of nicotine or tobacco, such program would be subject to ADA compliance, including the ADAs voluntary requirement. Although the text of the ACA includes a provision to allow higher premiums for tobacco users, it does not clarify exactly what constitutes tobacco use. 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). 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. That contrasts with participants in health-contingent wellness programs. Deductible (per person) Individual . Taxpayers are on the hook for $178 billion in federal funds allocated to hospitals and health care providers. Colorado limits the tobacco surcharge to 15%. 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. The total premium difference must not exceed 50% of the total cost of employee-only coverage under the plan (or, if an employees family can participate in the cessation program, the premium difference must not exceed 50% of the total cost of coverage in which an employee and any dependents are enrolled). Tobacco use includes these products: Chewing tobacco Cigarettes Cigars Pipes Hookah Snuff Not sure which Blue company you belong to? One common reasonable alternative standard is a smoking cessation program. First step: set a goal to quit with the Online Health Coach by selecting a quit date within the benefit year and completing all seven quit plan questions. Please review the terms of use and privacy policies of the new site you will be visiting. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association. *You must meet age requirements for prescribed tobacco cessation drugs to receive this benefit. Connecticut also prohibits tobacco surcharges, but only for health plans sold in the state's health insurance exchange (Access Health CT). and Blue Shield Association. HealthCareInsider COVID-19 Attitudes Survey 2022 Key Findings 39% of Americans think life function isChecked(){ %%EOF When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Supplemental Expense Claim. . rights reserved.Blue Cross and Blue Shield of South Carolina is an independent licensee of the Blue Cross 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. return 'medicare'; outlined on page 2. Penalizing employees who use tobacco may further disadvantage these individuals and arguably, these disadvantaged individuals may need an employers help the most. 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. 0000001462 00000 n The individual can make a request to involve a personal physicians recommendation at any time and the personal physician can adjust the physicians recommendations at any time, consistent with medical appropriateness. If you are experiencing difficulty accessing our website content or require help with site functionality, please use one of the contact methods below. Kaiser Family Foundation. rights reserved.BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross If youve been tobacco-free for at least six months, be sure to update this information on your application at www.HealthCare.gov. Lower-income Americans are more likely than higher-income Americans to use tobacco products. 0000005629 00000 n The default benefits coverage for a salaried employee are as listed: Basic Life Insurance 1.5 x salary Medical - Blue Cross Blue Shield PPO (National) - Employee only Smoker Surcharge - Yes Dental - MetLife Preventive Dental - Employee only Business Travel and Accident -basic coverage Long Term Disability - 50% coverage The Tobacco Surcharge amount for the current Plan Year is an additional : $80 : per month added to the health premium. Content is fact checked after it has been edited and before publication. You can also find your local BCBS company on BCBS.com. If we look at the nationwide average pre-subsidy premium in 2020, it's about $576 per month for health plans sold in the exchange. This tobacco surcharge will increase your monthly PAC contribution by 50%. The surcharge ($80 per month) applies if the member or any of the . Follow these steps: Once we receive and process this form, well remove the surcharge for the next billing cycle. If you have doubts, contact your health insurance company and discuss your e-cigarette habits. 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. Of course, it is always wise to engage legal counsel to help craft such programs. Health insurers took in more than $1.25 trillion to cover policies for function isChecked(){ The extra money being saved by participation is impossible to pass up given their financial situation. However, they cannot raise your copayments or coinsurance. Benefits are made available when services are reported using codes 99406 and . All Rights Reserved. We regulate the brand and licenses to all 36 Blue Cross and Blue Shield local companies. If you dont make this change, the tobacco surcharge will apply when the plan automatically renews. BlueEssentialsSM and Business BlueEssentialsSM plan members may pay a surcharge for recent tobacco use. 31 0 obj<>stream if (document.getElementById('inArticle_hc-radio1').checked == true){ Not to be cheeky, but youll pay through the nose. Under the Affordable Care Act (ACA), group health plans (and self-insured employers) can charge tobacco users up to 50% more for their health insurance premiums than non-tobacco users, and when they do this it is called a tobacco surcharge. } else { Louise Norris has been a licensed health insurance agent since 2003 after graduating magna cum laude from Colorado State with a BS in psychology. function isChecked(){ 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. outlined on page 2. Do you still have to pay the surcharge if you quit? If you are eligible for the Federal Employee Program (your member ID starts with the letter R immediately followed by numbers), your overseas claim form and instructions can be found here. 0000005920 00000 n rights reserved.BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Discrimination under the ADA includes requiring medical examinations and making disability-related inquiries, including medical history inquiries, unless 1 of 2 exceptions applies: (1) such exam or inquiry is job-related and consistent with business necessity; or (2) the medical exam is voluntary and part of an employee health program available at the worksite. 0000001332 00000 n New and Active State Employees Spousal Surcharge Waiver Application (IB25) . 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. Encouraging employees to quit tobacco can reduce healthcare costs while preventing lost 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. Tobacco Surcharge If you use tobacco products, there will be an extra charge on your PAC. ANTHEM BLUE CROSS AND BLUE SHIELD (ANTHEM) AND . 0000002188 00000 n 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 These are just some of the legal considerations employers should explore before adopting a tobacco user surcharge. Don't have your card? Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Member Discounts Take advantage of member-only discounts on health-related products and services. Health insurance premium levels depend on five key factors: The practice of demanding a surcharge for tobacco use is known as tobacco rating. "Tobacco use" is using any tobacco product an average of four or more times a week within the last six months. State specific rating variations. currently enrolled in the Blue Cross Blue Shield medical insurance plan. Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield independent licensees of the Blue Cross and Blue Shield Association. <<9d6d943e3a33a749be68bd45bcf2c1c9>]>> A: A tobacco penalty (also known as a surcharge) is considered a health-contingent wellness program because individuals are required to satisfy a standard related to a health factor in order to obtain the reward. If you dont want to share your information please submit a request from our contact page. A Preferred Provider Organization (PPO) is an arrangement designed to supply health care services at a discounted cost by providing incentives for members to use designated health providers (who contract with the PPO at a discount), but which also provides coverage for services rendered by health care providers who are not part of the PPO network. return 'medicare'; For more insurance terms and definitions, please see ourGlossary. There are several available. While this post may have links to lead generation forms, this wont influence our writing. We adhere to strict editorial standards to provide the most accurate and unbiased information. 0000002110 00000 n An Independent Licensee of the Blue Cross and Blue Shield Association FHV6-2111 Tobacco-Free Tool Kit Blue Cross and Blue Shield of Alabama offers the Tobacco-Free Tool Kit as a program guide to help educate your employees about the dangers of tobacco. But you can adjust it for the next enrollment period. This article will explain the federal rules that apply to tobacco surcharges, and how some states have modified those rules. Members who were impacted will receive a refund for any tobacco surcharge they paid from Jan. 1, 2020 to May 1, 2020for this member. Are Health Insurance Subsidies Based on This Years Income? Obviously, I expected the premium to be higher than the estimate and budgeted accordingly. Washington Post. You can also view a listing of Blue Cross and Blue Shield companies who participate inMedicare AdvantageandPrescription Drugchoices. We want to help you make educated healthcare decisions. But ACA allows individual and small group health insurers to adjust premiums based on just four factorsgeographic location, age, family size, and tobacco use. and UnitedHealthcare Active Employee Tobacco Surcharge Policy, and UnitedHealthcare Active Employee Non-Tobacco Surcharge Policy, Permanente Active Employee Tobacco Cessation Policy, Permanente Active Employee Non-Tobacco Cessation Policy, and UnitedHealthcare Retiree Tobacco Surcharge Policy, and UnitedHealthcare Retiree Non-Tobacco Surcharge Policy, Permanente Retiree Tobacco Cessation Policy, Permanente Retiree Non-Tobacco Cessation Policy, Summary Plan Description and Evidence of Coverage. An insurance company has the right to charge up to 50% higher premiums for tobacco users. Since any tobacco product is counted, this includes e-cigarettes and vaping, as well as traditional cigarettes, cigars, chewing tobacco, and pipe smoking. Plan members need to attest to their tobacco status in their Virgin Pulse portal by May 31, 2022. The EEOC does not consider tobacco cessation programs that merely ask employees whether they use tobacco and whether they ceased using tobacco upon completion of the program to be making disability-related inquiries or medical examinations.. Contact your local BlueCross and Blue Shield representative for details regarding claims or coverage. Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All In a participatory wellness program, a participant earns incentives merely by participating in the program. Federal Register. Regular prescription drug benefits will apply to smoking and tobacco cessation drugs not meeting these criteria. %PDF-1.6 % 0000013935 00000 n With that ruling, you can say the old tobacco policies went up in smoke. James received a Master of Library Science degree from Dominican University. Effectuated enrollment snapshot. Across all exchange enrollees, 86% qualify for premium subsidies that amount to an average of nearly $492 per month. Residents of California should use this form: CCPA Personal Information Request. Under the Affordable Care Act (ACA), insurers can charge higher premiums for tobacco users. Under the Affordable Care Act (ACA), group health plans (and self-insured employers) can charge tobacco users up to 50% more for their health insurance premiums than non-tobacco users, and when they do this it is called a tobacco surcharge. CMS announced a transitional policy and extensions to the policy that together allow issuers to continue to renew non-grandfathered policies that are not compliant with the ACA until October 1, 2021, so long as the coverage comes into compliance with applicable requirements by January 1, 2022. return 'health'; Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association Affidavit of Domestic Partnership for Benefits Eligibility When you add domestic partner coverage to your benefit program, the employee and his or her domestic partner must meet certain eligibility criteria. As a result, if a tobacco cessation program offers an incentive to test for a chemical related to tobacco use, the program must be mindful of the ADA voluntary requirement. HealthCare.gov. 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. This can help you determine the activities that trigger your cravings. Inpatient vs. Outpatient Care: Whats the Difference? } The estimate was about $89 per month and covered all the preventative care we wanted. The ADA prohibits employers from discriminating against individuals based on disability or perceived disability. If you are eligible for the Blue Cross Blue Shield Global Core program, enter the first three letters or numbers of your member ID here to access your international claim form and instructions. If you are on a personal connection, like at home, you can run an anti-virus scan on your device to make sure it is not infected with malware. Tobacco Surcharge The tobacco surcharge applied to certain employees' health insurance premiums is $80 per month, or $960 per calendar year. 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. The settlement followed months of. In some circumstances, an individual may not satisfy the reasonable alternative standard until the end of the year. There are lots of Medicare choices, including Medicare+Choice, medical savings accounts and private fee-for-service plans. Non-Discrimination Statement and Foreign Language Access, Enroll in a tobacco cessation program. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. These members will be responsible for paying a tobacco surcharge equal to 20 percent of their total monthly premium beginning Jan. 1, 2020. . Members Currently Not Paying the Tobacco Surcharge:If a member is not 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 not pay the tobacco surcharge. In those programs, incentives are tied to achieving a health status goal, such as not using tobacco or having a certain weight or blood pressure (outcomes-based). trailer We use cookies on this website to give you the best experience and measure website usage. You may also find more information about insurance for individuals and familiesandMedicare. Pesko MF, Bains J, Maclean JC, Cook BL. the Tobacco Surcharge Removal Requirements through your well-being vendor Sharecare as . But the rule excludes tobacco use for religious or ceremonial purposes. 0000006451 00000 n Internal Revenue Service; Employee Benefits Security Administration; Health and Human Services Department. How Did the Tax Cuts and Jobs Act Affect Individual Health Insurance? Use our frequently asked questions to find answers. Willis Towers Watson. 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 Free nicotine patches, gum or lozenges to eligible enrollees, Free one-on-one coaching session with a Quit Coach. James Lacy, MLS, is a fact-checker and researcher. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Eligible members can obtain tobacco cessation counseling from their primary care providers, as well as at their local CVS MinuteClinic. ENROLL! The Blue Cross Blue Shield Association is an . if (document.getElementById('inArticle_hc-radio1').checked == true){ function isChecked(){ 2020;39(5):871-875. doi:10.1377/hlthaff.2019.00709. 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. } 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). Health insurance surcharges for tobacco use declined among small employers In 2018. Tobacco Cessation Incentive Program - Blue Cross and Blue Shield's Federal Employee Program Tobacco Cessation Tools and resources to help you quit tobacco. Dental Expense Claim. Tobacco users can be charged up to 50% more than people who don't use tobacco. This includes over-the-counter medications with a prescription from the provider. They contend that many smokers begin the habit before they are 18. You will also find more detail about the benefit and the support that is available to help you quit successfully. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Overview: Final rule for health insurance market reforms. Follow These 8 Tips to Reduce Your Out-of-Pocket Healthcare Costs, 6 Things to Remember As You Negotiate Medical Bills, How to Save Money with Expanded Bronze Plans. if (document.getElementById('inArticle_hc-radio1').checked == true){ Does Short-Term Health Insurance Cover Essential Benefits? Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All We will review this form and make a determination on whether to remove the tobacco surcharge. %%EOF Therefore, regulations require employers to offer a reasonable alternative standard to earn the reward. 0000033900 00000 n Retirees (and other applicable individuals) who intentionally misrepresent the response to the surcharge question or fail to notify SHBP of changes to their response will permanently lose their SHBP health insurance with no right to reinstatement. An affidavit is a means by } if (document.getElementById('inArticle_hc-radio1').checked == true){ 2023 Obamacare Subsidy Chart and Calculator, ACA Eligibility Mistakes and Subsidy Repayment, 7 Healthcare Options If You Lose Your Obamacare Subsidy, Marketplace Insurance vs. 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. 0000006890 00000 n Market rating reforms. Health insurers consider you a smoker, subject to a hefty premium surcharge if you used any tobacco products four or more times a week in the past six months. Affordable Care Act Open Enrollment Period Snapshot Survey Key Findings 44% of We do not sell insurance products, but there may be forms that will connect you with partners of healthcare.com who do sell insurance products. Readers are encouraged to seek legal counsel for any advice or compliance determinations needed on specific situations. 1 cancer threat to men and women 34 million Americans still smoke regularly (14% ) and another 6 million use vaping nicotine inhalers. } During enrollment, you answered questions about tobacco usage. Tobacco Surcharges - Legal Rules Employers may consider implementing a smoking cessation program to encourage their employees to stop smoking or using tobacco products. Barbara J. Zabawa is the founder and president of the Center for Health and Wellness Law, LLC, a law firm dedicated to improving legal access and compliance for the health and wellness industries. If youre not honest about tobacco, you risk being charged with insurance fraud. We are committed to protecting and respecting your privacy. 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. Although the majority of states do allow insurers to impose tobacco surcharges of up to 50%, many insurers choose to use smaller surcharges or skip them altogether. rights reserved.Blue Cross and Blue Shield of South Carolina is an independent licensee of the Blue Cross You can find out by typing yourhome or work ZIP code in our Plan Finder. The EX Program qualifies as a reasonable alternative standard. Can Medical Bills Go on Your Credit Report? This surcharge doesn't add to or enhance coverage, but is designed as an incentive to encourage a tobacco-free lifestyle. Cigarette smoking and tobacco use among people of low socioeconomic status. 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). Can My Employer Reimburse My Individual Health Insurance Premiums? Obviously, being honest when you answer enrollment questions is in your best interest. Active employees (and other applicable individuals) will lose SHBP coverage for 12 months beginning on the date that their false response or failure to notify SHBP is discovered. The participant is not expected to achieve a certain wellness goal, such as losing a certain amount of weight or having a certain blood pressure level. What is a tobacco surcharge? You have the choice of two . Not to mention, youll very likely lose your insurance or at least be charged all the back money you owe as a smoker. By Louise Norris If youre ready to quit smoking or vaping or using tobacco, we can help you every step of the way. Preventive care benefits for all adults. Our mission is to provide information that will help everyday people make better decisions about buying and keeping their health coverage. The $25 surcharge (per person, per pay) applies to employees and spouses covered under the Einstein health plan. 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. They are therefore addicted and need help. U.S. Food and Drug Administration. Frequently Asked Questions | Blue Cross Blue Shield Home Learn Frequently Asked Questions Looking to find answers to your billing, claim forms, and other questions? 0000004589 00000 n } - The 15% premium tobacco surcharge may apply to you if you, your spouse or your children use tobacco. U.S. Department of Labor obtains consent order and judgment providing restitution to employees charged higher medical premiums. The ACA divides wellness program activities into 2 groups: participatory and health-contingent. But premiums are only added for up to three children under the age of 21, so a family with five children under the age of 21 will have the same premiums as a similar family with three children. 0000013746 00000 n return 'medicare'; Most Blue Cross NC members have 100% coverage for tobacco cessation counseling with their doctor and medications to help them quit tobacco. It means that any premium surcharge for tobacco use must not be so large that an employee feels forced to participate in the biometric screen. 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. Created by: Lisa Schroeder. UNITEDHEALTHCARE MEMBERS . Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Centers for Medicare and Medicaid Services. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. While we make every effort to keep the Provider Finder "up-to-date," it is always best to confirm any provider information you select from this utility with your local Blue Cross and Blue Shield representatives. US Department of Health and Human Services. 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 more information, view our privacy policy. These members will be responsible for paying a tobacco surcharge equal to 20 percent of their total monthly premium beginning Jan. 1, 2020. ACA Tax Question: Who Can You Claim as a Dependent? krisanapong detraphiphat / Moment / Getty Image. The cessation program must be reasonably designed to promote health or prevent disease. Complementary Content $ . 0000001803 00000 n But if they do use tobacco, the surcharge can result in unaffordable health insurance premiums for these applicants. xref If people remain uninsured because they can't afford health insurance, they're not able to access the free tobacco cessation coverage that's included with ACA-compliant health plans, and they're less likely to receive timely medical treatment when they need it. He also reports regularly for National Public Radios Robin Hood Radio and Parade magazine to help people make better health care decisions and save money, too.