Encouraging employees to quit tobacco can reduce healthcare costs while preventing lost 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. function isChecked(){ But if they do use tobacco, the surcharge can result in unaffordable health insurance premiums for these applicants. In some circumstances, an individual may not satisfy the reasonable alternative standard until the end of the year. 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. All tobacco users may have their tobacco surcharge removed by completing the wellness requirements outlined in the applicable Tobacco Surcharge Removal Policy below. Otherwise, contact your Blue Cross and Blue Shield company for assistance. 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. There are issues these companies should examine before doing so. 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. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. 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. You can use the Horizon Blue app, too! We Can Help How the program works Staying in touch with your coach Need help? Claims and Billing Doctors, Hospitals and Specialties Insurance Basics My Coverage and Benefits Purchasing Insurance Member Questions Regular prescription drug benefits will apply to smoking and tobacco cessation drugs not meeting these criteria. 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 must complete the Healthways Well Being Assessment and a telephonic well-being coaching program or any online tracking by December 15, 2017. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association. 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). Blue Cross Blue Shield. 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. Non-Discrimination Statement and Foreign Language Access. Do you have a Business BlueEssentials plan through a small employer? For example, requiring attendance nightly at a one-hour class would be unreasonable. Not all states have the same Tobacco Rating rules. Health insurance premium levels depend on five key factors: The practice of demanding a surcharge for tobacco use is known as tobacco rating. James received a Master of Library Science degree from Dominican University. The ADA prohibits employers from discriminating against individuals based on disability or perceived disability. Our editorial staff is comprised of industry professionals and experts on the ACA, private health insurance markets, and government policy. 129 0 obj <>stream } 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. Outside the United States. 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. Center for Consumer Information and Insurance Oversight. 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. In addition, if you intend to quit tobacco use as you should for your health and those around you cessation programs are included as preventive care under the ACAs 10 essential health benefits. 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. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. Adults who use tobacco products and are enrolled in Medi-Cal Managed Care (Medi-Cal) are covered for all FDA-approved tobacco cessation medications. You can take the Blue Health Assessment, check drug costs, change your address, request a member ID card and more. Use the link below to download it. ENROLL! function isChecked(){ This is the customer service number for questions about your health insurance coverage, benefits or treatment. Completing the CAPTCHA proves you are a human and gives you temporary access to the web property. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. 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. and Blue Shield Association. } else { 0000013746 00000 n Also known as a primary care provider, personal care physician or personal care provider. Employer health benefits survey. The Commonwealth Fund. Even such soft fraud is considered a misdemeanor and can result in sentences of probation, community service or even time in jail. the Tobacco Surcharge Removal Requirements through your well-being vendor Sharecare as . 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. An official website of the State of Georgia. 0000001727 00000 n endstream endobj 98 0 obj <. It takes 6 to 8 weeks to complete the Tobacco Surcharge Removal Requirements. But you can adjust it for the next enrollment period. 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. if (document.getElementById('inArticle_hc-radio1').checked == true){ Contact your local Blue Cross and Blue Shield companyfor details regarding billing. Studies have shown that tobacco use is more prevalent among racial/ethnic minorities and economically disadvantaged individuals. Our mission is to provide information that will help everyday people make better decisions about buying and keeping their health coverage. The EX Program qualifies as a reasonable alternative standard. Health-contingent programs are further divided between activity-only and outcomes-based programs. 2018 Mar;37(3):473-481. doi:10.1377/hlthaff.2017.1062, Bains J, Pesko MF, Maclean JC, Cook BL. 0000006664 00000 n If your nicotine cravings are hard to manage, you can get a prescription from your doctor for your eligible tobacco cessation drugs, including over-the-counter (OTC) products (see the list below). 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. The State Health Plan now offers Tobacco Cessation Counseling benefits for its members with health care coverage through Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Should smokers pay more for health insurance? HMO stands for Health Maintenance Organization, a health care system that assumes or shares both the financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily enrolled population in a particular geographic area, usually in return for a fixed, prepaid fee. ANTHEM BLUE CROSS AND BLUE SHIELD (ANTHEM) AND . HealthCare.gov. 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. Kliff, S. Big tobacco and anti-cancer activists agree: Health provision goes too far. If you answered yes, you may be paying a 20 percent surcharge. 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. If you smoke or vape or chew tobacco regularly, you can count on being hit with a hefty premium increase of up to 50%, either at work or if youre buying an Affordable Care Act (ACA) Obamacare plan on the Exchange Marketplace. 97 0 obj <> endobj You can have the surcharge removed. This means that a tobacco surcharge should be accompanied with some effort by the group health plan to help tobacco users get healthy. So if you smoke or vape, you need to understand the legislation and the probable higher costs of your health insurance. 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. Your member ID card is your key to using your medical plan benefits. 0000001803 00000 n Some call this difference in health insurance premium amounts a premium differential or a tobacco use surcharge.. 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. ACA Tax Question: Who Can You Claim as a Dependent? 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). To qualify for tobacco free . Lower-income Americans are more likely than higher-income Americans to use tobacco products. 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. 1 cancer threat to men and women 34 million Americans still smoke regularly (14% ) and another 6 million use vaping nicotine inhalers. Coaching is available for all tobacco products, including electronic cigarettes and vaping products. We adhere to strict editorial standards to provide the most accurate and unbiased information. if (document.getElementById('inArticle_hc-radio1').checked == true){ 0000014771 00000 n One more note, nicotine inhalers have been marketed as helping some people wean off their nicotine dependency and quit smoking altogether. SET. Sonia Barkat is the founder of Umbrella Pact and a contributing consultant to The Impact. Call your Horizon Health Guide at 1-800-414-SHBP (7427), weekdays, from 8 a.m. to 6 p.m., Eastern Time (ET), or sign in to chat or send an email. 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). Through the Tobacco Cessation Incentive Program, eligible members can get support and prescription drugs and/or over-the-counter tobacco (OTC) cessation products at no cost. ANTHEM BLUE CROSS AND BLUE SHIELD (ANTHEM) AND . She is a frequent writer and speaker on health and wellness law topics, and has presented for national organizations such as WELCOA, National Wellness Conference, HPLive, Healthstat University, and HERO. By continuing to use this website, you consent to these cookies. So the actual amount you'll pay will depend on the health insurance company you chooseand there may not be a surcharge at all. 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 you begin smoking regularly after youve joined a health insurance plan, you should tell your health insurance company when you renew your coverage (usually at the start of the year), if not sooner. 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. An official website of the State of Georgia. 0000033900 00000 n Of course, it is always wise to engage legal counsel to help craft such programs. Content is fact checked after it has been edited and before publication. 0000002022 00000 n Since any tobacco product is counted, this includes e-cigarettes and vaping, as well as traditional cigarettes, cigars, chewing tobacco, and pipe smoking. 0 But a subsequent rule issued by the Centers for Medicare and Medicaid Services defines tobacco use as the use of any tobacco product within the past six months with a frequency of at least four times per week. 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. DHEC offers a free program called the SouthCarolinaTobaccoQuitline. 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