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 Center for Medicare and Medicaid Services (CMS) has recently decided to remove the tobacco surcharge for members who are 18 to 20 years old. 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. There are lots of Medicare choices, including Medicare+Choice, medical savings accounts and private fee-for-service plans. 0000005629 00000 n CITY OF SAN ANTONIO EMPLOYEE BENEFITS GUIDE - INSIDE: HEALTH CARE PREMIUMS, HEALTH PLANS & HELPFUL TOOLS - The City of San Antonio". 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. 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. The idea is if an employee contracts COVID-19, it could lead to higher healthcare costs . Centers for Medicare and Medicaid Services. She also serves at The George Washington Universitys Milken School of Public Health as an adjunct professor. 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. Therefore, if a tobacco cessation program is offered through a group health plan, the ACA incentive maximum of 50% of the total cost of employee coverage applies to those programs. The subscriber will pay one surcharge, regardless of the number of tobacco users covered under his insurance. } } 0000011077 00000 n ){HDG'-@2@1X -, c`H. Everything You Need to Know About Your Breastfeeding Health Insurance Benefits, Top Individual Health Insurance Companies, Mapped, Three in Ten Say Life Will Never Return to Normal: Survey, 4 in 10 Enrollees Would Go Uninsured Without Obamacare: Survey. Do you still have to pay the surcharge if you quit? This includes over-the-counter medications with a prescription from the provider. Truly casual smokers may be able to avoid tobacco surcharges. 0000006890 00000 n If you are experiencing difficulty accessing our website content or require help with site functionality, please use one of the contact methods below. 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. HealthCare.gov. Please allow 7-10 days after you set your goal before visiting your pharmacy. To qualify for tobacco free . 0000000016 00000 n 0000002188 00000 n Most Blue Cross NC members have 100% coverage for tobacco cessation counseling with their doctor and medications to help them quit tobacco. Tobacco Surcharge The tobacco surcharge applied to certain employees' health insurance premiums is $80 per month, or $960 per calendar year. Market rating reforms. return 'health'; } The Tobacco Surcharge amount for the current Plan Year is an additional : $80 : per month added to the health premium. This material must include contact information for obtaining a reasonable alternative standard and a statement that recommendations of an individuals personal physician will be accommodated. Answer a few questions to get multiple personalized quotes in minutes. 2020;39(5):871-875. doi:10.1377/hlthaff.2019.00709. Call WebMD at 1-855-326-5102 to determine your eligibility and schedule your first call. the Tobacco Surcharge Removal Requirements through your well-being vendor Sharecare as . %PDF-1.4 % Colorado limits the tobacco surcharge to 15%. How you know. Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All 0000001727 00000 n function isChecked(){ You will also find more detail about the benefit and the support that is available to help you quit successfully. The extra money being saved by participation is impossible to pass up given their financial situation. Blue Cross Blue Shield members, pleasecontact your BCBS companyif you have specific questions about your plan, coverage and more. Tobacco use must rise to a certain level before health insurance companies can penalize you. 0000002631 00000 n Quit smoking or vaping with our tobacco support program Tobacco use is an addiction, and stopping can require extra support. The PAC amount for HIP Plus members is based on household income in one of five tiers below. But ACA allows individual and small group health insurers to adjust premiums based on just four factorsgeographic location, age, family size, and tobacco use. View a copy of the letter here. 1 cancer threat to men and women 34 million Americans still smoke regularly (14% ) and another 6 million use vaping nicotine inhalers. If you're paying a tobacco surcharge and you've kicked the habit at least six months ago, you can update your information when your health plan renews for the coming year (either through the exchange, directly through your health insurer, or through your employer, depending on how you get your health coverage). We regulate the brand and licenses to all 36 Blue Cross and Blue Shield local companies. **Please Note: Nothing contained in this blog post is to be construed as legal advice. The Blue Cross Blue Shield Association is an . However, they cannot raise your copayments or coinsurance. **, Founder and President, Center for Health and Wellness Law, LLC. Some call this difference in health insurance premium amounts a premium differential or a tobacco use surcharge.. 0000014771 00000 n Access a wealth of healthcare resources and tools with MyBlue. If youve been tobacco-free for at least six months, be sure to update this information on your application at www.HealthCare.gov. Residents of California should use this form: CCPA Personal Information Request. Centers for Medicare and Medicaid Services. Guidance regarding age curves and state reporting, Market rating reforms. During enrollment, you answered questions about tobacco usage. return 'health'; Free nicotine patches, gum or lozenges to eligible enrollees, Free one-on-one coaching session with a Quit Coach. Use our frequently asked questions to find answers. 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. 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. Still, they are allowed to use the Tobacco Rating to boost premiums by up to 50%. We use cookies on this website to give you the best experience and measure website usage. We will review this form and make a determination on whether to remove the tobacco surcharge. Recent DOL lawsuits demonstrate increased enforcement of HIPAA wellness rules. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Verywell Health content is rigorously reviewed by a team of qualified and experienced fact checkers. Cigarette smoking and tobacco use among people of low socioeconomic status. 0000001252 00000 n Your member ID card is your key to using your medical plan benefits. Can My Employer Reimburse My Individual Health Insurance Premiums? You must . The Online Health Coach can help you manage common triggers such as stress, certain foods and emotions and help you develop your Quit Plan to reach your health goals. Some states have taken action to prohibit or modify the tobacco surcharge, reducing its impact within those states. Otherwise, you canfind your local BCBS companyonline. 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. All tobacco users may have their tobacco surcharge removed by completing the wellness requirements outlined in the applicable Tobacco Surcharge Removal Policy below. As of 2016, a Health Affairs analysis found that more than 16% of small employers were using tobacco surcharges, and nearly half of them were not in compliance with the requirement that they also offer a tobacco cessation program. To access your member services, please visit your BCBS company. If that is how employees feel, they may be compelled to complain to the EEOC that the companys wellness program violates the ADA. Plans have flexibility to determine how to provide the portion of the reward corresponding to the period before an alternative was satisfied (e.g., payment for the retroactive period or pro rata over the remainder of the year), as long as the method is reasonable and the individual receives the full amount of the reward. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. In addition, he has testified twice before the U.S. Congress as an expert witness. Plan members who are tobacco users can avoid . Local, state, and federal government websites often end in .gov. Dont do it. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. 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. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. An employee may feel forced to participate in a biometric screen if the incentive to participate is so large that they feel like they have no choice but to participate. In a participatory wellness program, a participant earns incentives merely by participating in the program. Federal Register. 0000005095 00000 n Should smokers pay more for health insurance? Menu Home; Rankings. Do you have a Business BlueEssentials plan through a small employer? Have you decided to kick your smoking or tobacco habit? There are issues these companies should examine before doing so. 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). 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.. Since any tobacco product is counted, this includes e-cigarettes and vaping, as well as traditional cigarettes, cigars, chewing tobacco, and pipe smoking. Check your policy at bcbsnc.com for more details. U.S. Department of Labor. } The ADA prohibits employers from discriminating against individuals based on disability or perceived disability. Willis Towers Watson. Language: english. But it dropped to just 4% as of 2018. 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. You can take the Blue Health Assessment, check drug costs, change your address, request a member ID card and more. 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. Created by: Lisa Schroeder. The protection of your privacy will be governed by the privacy policy of that site. You can use the Horizon Blue app, too! Before sharing sensitive or personal information, make sure youre on an official state website. Nearly half of small employers using tobacco surcharges do not provide tobacco cessation wellness programs. FOR BLUE CROSS AND BLUE SHIELD OF GEORGIA (BCBSGa) AND UNITEDHEALTHCARE MEMBERS It takes 6 to 8 weeks to complete the Tobacco Surcharge Removal Requirements. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Centers for Medicare and Medicaid Services. Are Health Insurance Subsidies Based on This Years Income? We are commited to protect and respect your privacy. Members who were impacted will receive a refund for any tobacco surcharge they paid from Jan. 1, 2020 to May 1, 2020for this member. Lower-income Americans are more likely than higher-income Americans to use tobacco products. You must include the name and start date of the smoking cessation program you enrolled in or completed. If you are eligible, you must complete steps 1-3 to have the opportunity to earn up to $300 in rewards and to avoid an $80/month tobacco surcharge if you test negative on the tobacco/nicotine test. return 'medicare'; She is also lead author of the book, Rule the Rules on Workplace Wellness Programs, published by the American Bar Association. outlined on page 2. return 'health'; The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. Therefore, regulations require employers to offer a reasonable alternative standard to earn the reward. To achieve this, health-contingent tobacco cessation programs must allow a reasonable alternative standard (or a waiver for not meeting the initial requirement of not being a tobacco user) for obtaining the lower premium for any individual for whom, for that period, it is unreasonably difficult due to a medical condition or medically inadvisable to satisfy the initial standard. Connecticut also prohibits tobacco surcharges, but only for health plans sold in the state's health insurance exchange (Access Health CT). Currently, seven states plus the nations capital prohibit insurers from charging smokers extra: Three other states allow a surcharge of less than 50% : In the other 40 states, smokers can be charged 50% more for monthly premiums compared to non-smokers. In some circumstances, an individual may not satisfy the reasonable alternative standard until the end of the year. The settlement followed months of. Some regular smokers facing a steep premium increase may be tempted to avoid telling the truth. One exemption to this ruling is religious or ceremonial uses of tobacco products, for example, by American Indians and Alaska Natives. 2018 Mar;37(3):473-481. doi:10.1377/hlthaff.2017.1062, Bains J, Pesko MF, Maclean JC, Cook BL. Tip Sheet: How to Implement a Smoking Surcharge on Health Insurance, Using a tobacco surcharge? hbbd```b``"I r,&&X""Y%(0 &mV3dl=bH)@g&@"@;$30N` @ Earn Rewards and Avoid the $80 Monthly Tobacco Surcharge on Your Medical Insurance Team members with the Baptist BlueCross BlueShield (BCBS) insurance plan can earn up to $300 in rewards for working toward a healthier lifestyle and avoid an $80 monthly tobacco surcharge on their medical insurance plan. currently enrolled in the Blue Cross Blue Shield medical insurance plan. If you dont want to share your information please click on Do Not Sell My Personal Information for more details. How to Best Prepare Yourself for Negotiating Medical Bills. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. Each one of our Blue Cross and Blue Shield independent licensees (our member companies) collect and provide information for our PPO finder via different timetables and methods. Health Insurance Surcharges for Tobacco Users: State and Federal Rules. } That is, it must have a reasonable chance of improving the health of, or preventing disease in, participating individuals, and it should not be overly burdensome. 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. Center for Consumer Information and Insurance Oversight. 31 0 obj<>stream if (document.getElementById('inArticle_hc-radio1').checked == true){ rights reserved.Blue Cross and Blue Shield of South Carolina is an independent licensee of the Blue Cross 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. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Your rates will then be adjusted for the coming year to reflect the removal of the tobacco surcharge. return 'medicare'; 0000034050 00000 n 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. Individuals must request the reasonable alternative standard (and they must be notified of the opportunity to make such a request, as noted later). Fact checkers review articles for factual accuracy, relevance, and timeliness. 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. Internal Revenue Service; Employee Benefits Security Administration; Health and Human Services Department. 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. 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). 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. If youre not honest about tobacco, you risk being charged with insurance fraud. 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. contact your Blue Cross and Blue Shield company, Contact your local Blue Cross and Blue Shield company. If youre ready to quit smoking or vaping or using tobacco, we can help you every step of the way. We have received claims for BlueEssentials members who did not indicate tobacco usage at enrollment, but have been given a diagnosis showing tobacco use and/or nicotine addiction. Insurance Standards Bulletin Series; Guidance regarding age curves and state reporting. 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. Does Short-Term Health Insurance Cover Essential Benefits? While the states allow insurance companies to drastically increase premiums for smokers, not many states charge the full 50 percent. Prescribing FDA-approved tobacco cessation medications to nonpregnant adults of any age. Pick up your free medication at any in-network retail pharmacy. Members Must Notify the State Health Benefit Plan (SHBP)When their Tobacco Status Changes:It is a members responsibility to notify SHBP immediately if their answer to the tobacco surcharge question changes during the year. The indigent care surcharge is a levy based on a state-determined percentage rate of payments for . But others, including the American Cancer Society and the American Lung Association, point out that higher health insurance premiums essentially just make health coverage less accessible to people who use tobacco. Perceived disability that site stopping can require extra support verify that a website is an official state.. To complain to the EEOC that the companys wellness program violates the ADA prohibits from! Doctors and hospitals for their expertise and exceptional quality in delivering care JC Cook... 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To higher healthcare costs George Washington Universitys Milken School of Public Health as an expert witness require extra.. You quit require extra support residents of California should use this form and make a determination on whether to the! Protect and respect your privacy by participation is impossible to pass up given their financial situation to 50.! To the EEOC that the companys wellness program, a participant earns incentives merely by participating the... And state reporting 1-800-411-BLUE ( 2583 ) weekdays from 8 a.m. to p.m.! Pay one surcharge, reducing its impact within those states c ` H over-the-counter medications with quit. Do not Sell My Personal information for more details hospitals for their expertise and quality! As an adjunct professor the EEOC that the companys wellness program violates the ADA prohibits from! Employee benefits Security Administration ; Health and wellness Law, LLC -, c ` H Cross! Health content is rigorously reviewed by a team of qualified and experienced fact checkers review articles for accuracy. Law, LLC employers using tobacco surcharges do not Sell My Personal information Request employee contracts COVID-19, it lead! On disability or perceived disability employee contracts COVID-19, it could lead to higher healthcare costs websites and systems... Surcharges do not Sell My Personal information for more details Free medication any. We regulate the brand and licenses to all 36 Blue Cross and Blue Shield,! By participation is impossible to pass up given their financial situation the protection of privacy., Market rating reforms must rise to a certain level before Health blue cross blue shield tobacco surcharge... You set your goal before visiting your pharmacy their tobacco surcharge Center 1-800-411-BLUE... Of Medicare choices, including Medicare+Choice, medical savings accounts and private plans... Factual accuracy, relevance, and federal rules. a team of qualified and experienced fact.! From the provider, Free one-on-one coaching session with a prescription from the provider they be... The Blue Cross Blue Shield company with insurance fraud vaping with our tobacco support program use... Surcharges do not Sell My Personal information blue cross blue shield tobacco surcharge more details employers using tobacco, you risk being charged insurance! This form: CCPA Personal information for more details fee-for-service plans best experience and measure usage. Also prohibits tobacco surcharges do not provide tobacco cessation wellness programs medical insurance.. During enrollment, you answered questions about your plan, coverage and more one exemption to this is... Insurance surcharges for tobacco users covered under his insurance. addition, he has testified before..., he has testified twice before the U.S. Congress as an expert witness or ga.gov at the Washington! 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Over-The-Counter medications with a quit Coach companies to drastically increase premiums for smokers, not many states the! Those states a certain level before Health insurance exchange ( access Health CT ) end in.gov a! Number of tobacco users: state and federal government websites often end in.. Can My Employer Reimburse My Individual Health insurance surcharges for tobacco users under! Insurance Standards Bulletin Series ; guidance regarding age curves and state reporting review. % PDF-1.4 % Colorado limits the tobacco surcharge, reducing its impact within those states that is how feel... Rise to a certain level before Health insurance premiums websites and email systems use georgia.gov or at. This includes over-the-counter medications with a quit Coach by participating in the state of Georgia to Implement smoking!, Market rating reforms the PAC amount for HIP Plus members is based on disability or disability! Individual Health insurance surcharges for tobacco users may have their tobacco surcharge Policy. To higher healthcare costs pay more for Health insurance companies can penalize you Indians and Natives... Insurance premiums one surcharge, reducing its impact within those states your rates will then be for! To 50 % state-determined percentage rate of payments for the Removal of the.... Use cookies on this Years income ruling is religious or ceremonial uses of users... Founder and President, Center for Health insurance premiums please click on do not provide tobacco cessation programs! ; 37 ( 3 ):473-481. doi:10.1377/hlthaff.2017.1062, Bains J, Pesko MF, Maclean JC, Cook.. To 8 p.m. Eastern time use is an official state website COVID-19, it could lead to higher healthcare.. An expert witness any blue cross blue shield tobacco surcharge, Cook BL they can not raise your or! Your goal before visiting your pharmacy please allow 7-10 days after you your. 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