The Blue Cross Blue Shield PPO plan rates will increase by 5% and the High . Content is fact checked after it has been edited and before publication. The idea is if an employee contracts COVID-19, it could lead to higher healthcare costs . ENROLL! 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. UNITEDHEALTHCARE MEMBERS . Claims and Billing Doctors, Hospitals and Specialties Insurance Basics My Coverage and Benefits Purchasing Insurance Member Questions The Blue Cross Blue Shield Association is an . How you know. 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. Leading the way in health insurance since 1929. 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. Verywell Health content is rigorously reviewed by a team of qualified and experienced fact checkers. Therefore, regulations require employers to offer a reasonable alternative standard to earn the reward. State laws may also be implicated, but this blog post focuses on federal laws only. To receive benefits for over the-counter smoking and tobacco cessation drugs, you must have a physician's prescription for each OTC drug, which you must fill at an in-network retail pharmacy. Obviously, I expected the premium to be higher than the estimate and budgeted accordingly. Health insurance premiums vary from one zip code to another. return 'medicare'; So the actual amount you'll pay will depend on the health insurance company you chooseand there may not be a surcharge at all. Individuals must request the reasonable alternative standard (and they must be notified of the opportunity to make such a request, as noted later). There are issues these companies should examine before doing so. 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. In addition, he has testified twice before the U.S. Congress as an expert witness. These products dont use tobacco; however, they contain other harmful substances, including addictive nicotine. A family of five will pay more than a family of three since the additional children will have premiums. Free nicotine patches, gum or lozenges to eligible enrollees, Free one-on-one coaching session with a Quit Coach. 0000011077 00000 n Your medical coverage is provided by Blue Cross and Blue Shield of Louisiana (BCBSLA). Tobacco Surcharge The tobacco surcharge applied to certain employees' health insurance premiums is $80 per month, or $960 per calendar year. Health Insurance Alabama | Blue Cross and Blue Shield of Alabama During the Public Health Emergency (PHE), over-the-counter (OTC) COVID-19 FDA-authorized test kits are covered for eligible members and will be reimbursed with no member cost share based on the federal guidance. Complementary Content $ . If youre not honest about tobacco, you risk being charged with insurance fraud. 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). Centers for Medicare and Medicaid Services. Check out the changes and updates to our plan in 2023. "Tobacco use" is using any tobacco product an average of four or more times a week within the last six months. 0000013935 00000 n Plan members need to attest to their tobacco status in their Virgin Pulse portal by May 31, 2022. 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. The ACA allows tobacco surcharges, but some states limit them. Our editorial staff is comprised of industry professionals and experts on the ACA, private health insurance markets, and government policy. By continuing to use this website, you consent to these cookies. Kliff, S. Big tobacco and anti-cancer activists agree: Health provision goes too far. } What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. 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. 2023 Blue Cross Blue Shield Association. Readers are encouraged to seek legal counsel for any advice or compliance determinations needed on specific situations. Some states have taken action to prohibit or modify the tobacco surcharge, reducing its impact within those states. The surcharge is an extra charge on health plan premiums for 0000033900 00000 n Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All } 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. By Louise Norris Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All - Thurs. Instead, the insurance companies generally charge tobacco users 10-20 percent higher rates. The surcharge ($80 per month) applies if the member or any of the . } else { 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. 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. 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. And in California, the District of Columbia, Massachusetts, New Jersey, New York, Rhode Island, and Vermont, insurers are not allowed to charge tobacco users higher premiums. 0000014771 00000 n Money Saving Health Insurance Tips for Spouses. Member Discounts Take advantage of member-only discounts on health-related products and services. With that ruling, you can say the old tobacco policies went up in smoke. This includes over-the-counter medications with a prescription from the provider. You may be wondering how this positive lifestyle change affects your coverage. 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. We are commited to protect and respect your privacy. 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. 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. 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. The facts on the FDA's new tobacco rule. This program is available to members with PPO or HMO coverage. Tobacco use includes these products: Chewing tobacco Cigarettes Cigars Pipes Hookah Snuff To learn more, visit our Employers page. Centers for Disease Control and Prevention. They contend that many smokers begin the habit before they are 18. %%EOF Local, state, and federal government websites often end in .gov. The subscriber will pay one surcharge, regardless of the number of tobacco users covered under his insurance. 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. Your member ID card is your key to using your medical plan benefits. 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. Menu Home; Rankings. If you have doubts, contact your health insurance company and discuss your e-cigarette habits. Asia Pacific; EMEA; Latin America; UK Solicitors; UK Bar; United States Effectuated enrollment snapshot. currently enrolled in the Blue Cross Blue Shield medical insurance plan. 0000034050 00000 n Connecticut also prohibits tobacco surcharges, but only for health plans sold in the state's health insurance exchange (Access Health CT). Health Aff (Millwood). return 'health'; 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. Private Health Insurance Plans, How to Choose Between Major Medical Insurance and a High-Deductible Health Plan, Here Are Free or Discounted Healthcare Options If Youre Underinsured, Special Enrollment Periods and Qualifying Life Events, Lost Your Medicaid? By 2017, the prevalence of tobacco surcharges among small employers' health plans had grown to nearly 18%. If youre ready to quit smoking or vaping or using tobacco, we can help you every step of the way. Centers for Medicare and Medicaid Services. There are several available. 0000004589 00000 n Penalizing employees who use tobacco may further disadvantage these individuals and arguably, these disadvantaged individuals may need an employers help the most. You must complete the Healthways Well Being Assessment and a telephonic well-being coaching program or any online tracking by December 15, 2017. 2020;39(5):871-875. doi:10.1377/hlthaff.2019.00709. Pesko MF, Bains J, Maclean JC, Cook BL. 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. If you don't make this change, the tobacco surcharge will apply when the plan automatically renews. 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). 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. 0000001727 00000 n outlined on page 2. 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. 0000005095 00000 n Eligible members can obtain tobacco cessation counseling from their primary care providers, as well as at their local CVS MinuteClinic. For more information, visit our COVID-19 information page. Blue Shield Association. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. The surcharge ($80 per month) applies if the member or any of the . UNITEDHEALTHCARE MEMBERS . 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. 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. Use our frequently asked questions to find answers. 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. BlueEssentialsSM and Business BlueEssentialsSM plan members may pay a surcharge for recent tobacco use. Most Blue Cross NC members have 100% coverage for tobacco cessation counseling with their doctor and medications to help them quit tobacco. That depends on your plan. While this post may have links to lead generation forms, this wont influence our writing. The program must give individuals eligible for the tobacco cessation program the opportunity to qualify for the lower premium at least once per year. Arkansas limits it to 20%, and Kentucky limits it to 40%. 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 return 'health'; All Rights Reserved. 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. However, they cannot raise your copayments or coinsurance. The ADA prohibits employers from discriminating against individuals based on disability or perceived disability. For most Blue Cross members: Quitting tobacco and vaping support line Call toll-free 1-888-662-BLUE (2583) Hours: Mon. SET. Heres What to Do Next, Health Insurance After Divorce: Your Options, Turning 26: Health Insurance Guide for Those Aging Off Their Parents Plan, How to Keep Your Doctor When Your Health Insurance Changes, Health Insurance After the Death of a Spouse, Parent or Other Plan Member. 1 cancer threat to men and women 34 million Americans still smoke regularly (14% ) and another 6 million use vaping nicotine inhalers. James Lacy, MLS, is a fact-checker and researcher. . Answer a few questions to get multiple personalized quotes in minutes. Verywell Health's content is for informational and educational purposes only. Quit smoking or vaping with our tobacco support program Tobacco use is an addiction, and stopping can require extra support. Centers for Medicare and Medicaid Services. 0000002110 00000 n These are just some of the legal considerations employers should explore before adopting a tobacco user surcharge. Tobacco Cessation Incentive Program - Blue Cross and Blue Shield's Federal Employee Program Tobacco Cessation Tools and resources to help you quit tobacco. 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). This charge will remain through the end of the benefit year. One common reasonable alternative standard is a smoking cessation program. For assistance with Medicare plans dial 888-391-5203. 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. This might be through providing follow-up information or advice designed to improve the health of tobacco using employees. They are therefore addicted and need help. Therefore, regulations require employers to offer a reasonable alternative standard to earn the reward. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association. This surcharge doesn't add to or enhance coverage, but is designed as an incentive to encourage a tobacco-free lifestyle. Have you decided to kick your smoking or tobacco habit? Experience Rating in Health Insurance, Here's Where Health Insurance Costs Are Rising in 2023 and What You Can Do About It, How Health Insurance Companies Prevent Adverse Selection. Use the link below to download it. Nearly half of small employers using tobacco surcharges do not provide tobacco cessation wellness programs. Tobacco users can be charged up to 50% more than people who don't use tobacco. Members who were impacted will receive a refund for any tobacco surcharge they paid from Jan. 1, 2020 to May 1, 2020for this member. If you dont want to share your information please submit a request from our contact page. <<9d6d943e3a33a749be68bd45bcf2c1c9>]>> hb```f`` Ab@CCHQ `q `a`|XLAi:Luv0ry[{!*V7 }@ni& @"` Insurance premiums could rise across the board. 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). Can My Employer Reimburse My Individual Health Insurance Premiums? The Center for Consumer Information & Insurance Oversight. These members will be responsible for paying a tobacco surcharge equal to 20 percent of their total monthly premium beginning Jan. 1, 2020. . We will review this form and make a determination on whether to remove the tobacco surcharge. While the states allow insurance companies to drastically increase premiums for smokers, not many states charge the full 50 percent. Pick up your free medication at any in-network retail pharmacy. The PAC amount for HIP Plus members is based on household income in one of five tiers below. } Tobacco Surcharge The tobacco surcharge applied to certain employees' health insurance premiums is $80 per month, or $960 per calendar year. rights reserved.Blue Cross and Blue Shield of South Carolina is an independent licensee of the Blue Cross Blue Cross Blue Shield. A physician or other medical professional who serves as a group member's first contact with a company's health care system. 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. } 0 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 you answered yes, you may be paying a 20 percent surcharge. return 'health'; Studies have shown that tobacco use is more prevalent among racial/ethnic minorities and economically disadvantaged individuals. Deductible (per person) Individual . 0000033336 00000 n In addition, the smoking surcharge does not qualify for ACA premium subsidies; you pay the premium entirely out of your pocket. For example, requiring attendance nightly at a one-hour class would be unreasonable. 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. Preventive care benefits for all adults. 0000002631 00000 n *You must meet age requirements for prescribed tobacco cessation drugs to receive this benefit. Tools and resources to help you quit tobacco. 0000006451 00000 n This update is effective as of January 1, 2020. xref For more information about legal considerations with tobacco surcharges, please connect with me at Center for Health and Wellness Law, LLC. 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. 0000001803 00000 n Also, an individual must be given the opportunity to comply with the recommendations of the individuals personal physician as a second reasonable alternative standard to meeting the reasonable alternative standard defined by the plan, but only if the physician joins in the request. 0000005920 00000 n Incentives (such as a premium differential) tied to not using tobacco is an outcomes-based wellness program. Not to mention, youll very likely lose your insurance or at least be charged all the back money you owe as a smoker. Employer health benefits survey. She is also lead author of the book, Rule the Rules on Workplace Wellness Programs, published by the American Bar Association. 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. 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. Some call this difference in health insurance premium amounts a premium differential or a tobacco use surcharge.. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. 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. 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