These questions and answers are for general information purposes only. This information does not create an employment contract between the employee and the agency. This information does not create any contractual rights or entitlements. The agency reserves the right to revise the content of this information, in whole or in part. No promises or assurances, whether written or oral, which are contrary to or inconsistent with the terms of this paragraph create any contract of employment. This information does not constitute tax or legal advice.
Tobacco Use Certification
Q. What is the tobacco-user surcharge?
A. This surcharge, effective January 1, 2011, adds $40 per month to the health insurance premium of a subscriber with single coverage who uses tobacco or $60 per month to the health insurance premium of a subscriber who covers his spouse or children if he or anyone he covers uses tobacco products or has used tobacco products within the past six months.
Q. Do members covered under the AMRA TRICARE Supplement Plan pay the tobacco surcharge?
A. No. The surcharge only applies to members covered under the State Health Plan and BlueChoice HealthPlan.
Q. Do I have to certify my tobacco use again?
A. You only need to recertify your tobacco use if your tobacco use, or the tobacco use of anyone you cover, has changed. For example, if you have not used tobacco in six months, you can change your certification from smoker to nonsmoker. To do so, fill out the Certification Regarding Tobacco Use form. You can also get a copy of the form from your benefits administrator.
Q. How do I avoid the surcharge?
A. The surcharge will be added automatically to your health insurance premiums, unless you complete a Certification Regarding Tobacco Use form and return it to your benefits administrator for manual processing.
If your physician provides a letter that states it is unreasonably difficult due to a medical condition for you to stop using tobacco or that it is medically inadvisable for you to stop using tobacco, you may qualify for a waiver of the tobacco-use surcharge. Please give the letter to your benefits administrator, who will send it to PEBA Insurance Benefits.
Q. What is considered tobacco use?
A. Tobacco use is smoking tobacco in such forms as a cigarette, pipe or cigar, or using smokeless tobacco, such as snuff or chewing tobacco, within the past six months.
Use of non-tobacco cigarettes, such as nicotine inhalers or electronic (green) cigarettes, does not require you to pay the tobacco surcharge.
Q. How often do I need to certify my status as a tobacco user or non-tobacco user?
A. Once your certification is received and processed, you need not recertify unless the status changes for you or a covered family member.
Q. Why has the surcharge been implemented?
A. Tobacco is considered the leading preventable risk factor for illness and disease. The Budget and Control Board approved the surcharge because of the high cost of tobacco use to all PEBA Insurance Benefits health plans – an estimated $75 million a year for tobacco-related illnesses.
Several other state health plans have added, or are adding, a surcharge for tobacco use: Alabama, Georgia, Kansas, Kentucky, Indiana, North Carolina, South Dakota, Tennessee and West Virginia. Many private companies are doing the same.
Q. I don’t smoke or use tobacco, but my spouse, who is on my plan as a dependent, does. Do we have to pay the surcharge?
A. Yes. If you or any covered family members use tobacco products or have used tobacco products within the past six months, the $60-per-month surcharge applies.
Q. More than one of us in the family uses tobacco. Do I have to pay more than the $60 surcharge?
A. No. If more than one covered family member uses tobacco, the surcharge is still $60.
Q. If I’m still using tobacco, what can I do to avoid the surcharge?
A. PEBA Insurance Benefits cares about your health and would like for everyone to be eligible for the lower premium. Once you and family members you cover are tobacco free for six months, you can apply to have the surcharge removed. See “How do I avoid the surcharge?” above. And, there’s help available to increase your chances of quitting successfully. Read on.
Q. I want to quit using tobacco but need help to do it. What should I do?
A. Free tobacco cessation programs are offered by the health plans available through PEBA Insurance Benefits.State Health Plan members are eligible for the American Cancer Society Quit for Life Program. As part of it, a Quit Coach works with each participant to create a personalized, 12-month Quit Plan. Free nicotine replacement products are provided, if appropriate. A coach also may recommend a smoking cessation drug, which is available through both plans’ prescription drug coverage. To register, call 866-QUIT-4-LIFE (866-784-8454) or click on the Prevention Partners button on the PEBA Insurance Benefits website at www.eip.sc.gov.
BlueChoice HealthPlan members may enroll in the Quit Smoking program offered through Great Expectations for Health.
*You cannot complete your tobacco-use certification through these tobacco-cessation programs. You must certify through PEBA Insurance Benefits by completing a form as described under "How do I avoid the surcharge" above.
Prevention Partners periodically conducts tobacco management programs that are free to subscribers and their covered family members. Under Prevention Partners on the PEBA Insurance Benefits website, click on the Training Calendar and look for Tobacco Management.
Q. What if I use tobacco but apply for the discount anyway? What are the penalties if this is discovered?
A. If it is determined that you or anyone you cover has used tobacco products within the past six months or started using tobacco products after the date of your certification as non-tobacco user(s), and you did not notify PEBA Insurance Benefits, you will be subject to penalties including, but not limited to:
- Payment of the additional $40 or $60 surcharge, plus a 10-percent penalty, for each month since your last certification
- Elimination of the out-of-pocket coinsurance maximum for the current and the subsequent year.
For example, you cover yourself and your spouse and you certify that you are both tobacco free during the initial certification period. You do not pay the surcharge that starts with your January premium. In October, it is discovered and reported to your benefits office that you DO use tobacco and this report is verified.
- You would pay the surcharge due from January through October, which is 10 months (10 X $60 = $600)
- You would also pay the 10-percent penalty for those 10 months ($60 X 10% = $6 X 10 = $60)
- Your out-of-pocket/coinsurance maximum is suspended for 2012 and 2013, meaning you must continue to pay coinsurance on covered charges. Maximums are:
- State Health Plan: $2,000 for single coverage and $4,000 for family coverage for covered charges in network
- BlueChoice HealthPlan: $2,000 for single coverage and $4,000 for family coverage for covered charges.
Q. What is the alternative program I've heard about?
A. If your physician provides a letter that states that it is unreasonably difficult due to a medical condition for you to stop using tobacco or that it is medically inadvisable for you to stop using tobacco, you may qualify for a waiver of the tobacco-use surcharge. Please give the letter to your benefits administrator, who will send it to the PEBA Insurance Benefits.