The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. } To access your member services, please visit your BCBS company. Completing the CAPTCHA proves you are a human and gives you temporary access to the web property. While this post may have links to lead generation forms, this wont influence our writing. Samara Lorenz, Director, Oversight Group. The PAC amount for HIP Plus members is based on household income in one of five tiers below. Insurance companies and some experts justify the large surcharge acts as an incentive to convince smokers to quit. 0000006451 00000 n 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. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. 0000014771 00000 n 0000001462 00000 n Can Medical Bills Go on Your Credit Report? **Please Note: Nothing contained in this blog post is to be construed as legal advice. For more insurance terms and definitions, please see ourGlossary. So before implementing any tobacco surcharges, be sure to check if your state law also adds restrictions. Health insurers took in more than $1.25 trillion to cover policies for function isChecked(){ Our editorial staff is comprised of industry professionals and experts on the ACA, private health insurance markets, and government policy. krisanapong detraphiphat / Moment / Getty Image. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. By law, all ACA Obamacare health plans cannot reject tobacco users. 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. } return 'health'; U.S. Food and Drug Administration. %PDF-1.6 % 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. 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. For most Blue Cross members: Quitting tobacco and vaping support line Call toll-free 1-888-662-BLUE (2583) Hours: Mon. You can also find your local BCBS company on BCBS.com. 0000034050 00000 n Your rates will then be adjusted for the coming year to reflect the removal of the tobacco surcharge. Otherwise, contact your Blue Cross and Blue Shield company for assistance. 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. Does Short-Term Health Insurance Cover Essential Benefits? Willis Towers Watson. But ACA allows individual and small group health insurers to adjust premiums based on just four factorsgeographic location, age, family size, and tobacco use. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Prescribing FDA-approved tobacco cessation medications to nonpregnant adults of any age. 0000033900 00000 n You must include the name and start date of the smoking cessation program you enrolled in or completed. Benefits are made available when services are reported using codes 99406 and . We want to help you make educated healthcare decisions. But you can adjust it for the next enrollment period. The Commonwealth Fund. Thank you, {{form.email}}, for signing up. You must complete the Healthways Well Being Assessment and a telephonic well-being coaching program or any online tracking by December 15, 2017. Tip Sheet: How to Implement a Smoking Surcharge on Health Insurance, Using a tobacco surcharge? 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. Incentives for nondiscriminatory wellness programs in group health plans. %%EOF Still, they are allowed to use the Tobacco Rating to boost premiums by up to 50%. If you have doubts, contact your health insurance company and discuss your e-cigarette habits. Centers for Medicare and Medicaid Services. 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). 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. New and Active State Employees Spousal Surcharge Waiver Application (IB25) . Moreover, the time commitment required for the reasonable alternative standard must be reasonable. return 'health'; Note that we cannot remove it retroactively. 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. 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. return 'medicare'; } Complementary Content $ . Not sure which Blue company you belong to? Contact your local BlueCross and Blue Shield representative for details regarding claims or coverage. 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. While the states allow insurance companies to drastically increase premiums for smokers, not many states charge the full 50 percent. A family of five will pay more than a family of three since the additional children will have premiums. Some regular smokers facing a steep premium increase may be tempted to avoid telling the truth. Recent DOL lawsuits demonstrate increased enforcement of HIPAA wellness rules. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Health insurance premiums vary from one zip code to another. Not to be cheeky, but youll pay through the nose. 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. Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All 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. Your member ID card is your key to using your medical plan benefits. 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. Centers for Medicare and Medicaid Services. Pick up your free medication at any in-network retail pharmacy. 0 The ACA divides wellness program activities into 2 groups: participatory and health-contingent. This tobacco surcharge will increase your monthly PAC contribution by 50%. The next time you sign up for health insurance, youll be asked whether you smoke and how often. There are several available. Market rating reforms. Not to mention, youll very likely lose your insurance or at least be charged all the back money you owe as a smoker. I was shocked when. Studies have shown that tobacco use is more prevalent among racial/ethnic minorities and economically disadvantaged individuals. Setting up a tobacco surcharge may seem straight forward but for it to be effective, you need to be strategic. 0000006154 00000 n You can use the Horizon Blue app, too! By 2017, the prevalence of tobacco surcharges among small employers' health plans had grown to nearly 18%. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. 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. Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. 0000013935 00000 n 0000002631 00000 n She is also lead author of the book, Rule the Rules on Workplace Wellness Programs, published by the American Bar Association. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. The cost of coverage includes the total amount of employer and employee contributions toward the benefit package under which the employee is (or the employee and any dependents are) receiving coverage. We use cookies on this website to give you the best experience and measure website usage. 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. return 'medicare'; 97 0 obj <> endobj They contend that many smokers begin the habit before they are 18. 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. More employers are considering a premium surcharge on employees participating in the company's health plan who are not vaccinated. 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. "Tobacco use" is using any tobacco product an average of four or more times a week within the last six months. It takes 6 to 8 weeks to complete the Tobacco Surcharge Removal Requirements. Even such soft fraud is considered a misdemeanor and can result in sentences of probation, community service or even time in jail. If the reasonable alternative standard is a digital tobacco cessation program, the plan must make the program available, and may not require the individual to pay for the cost of the program. 31 0 obj<>stream Check out the changes and updates to our plan in 2023. In addition, he has testified twice before the U.S. Congress as an expert witness. 0000006664 00000 n To learn more, visit our Employers page. 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. 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. 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). 29 0 obj <> endobj Will My Uninsured Medical Expenses Count Toward My Deductible? 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. 129 0 obj <>stream During enrollment, you answered questions about tobacco usage. 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. To qualify for tobacco free . 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. 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. UNITEDHEALTHCARE MEMBERS . Menu Home; Rankings. Although lawmakers who wrote the ACA felt strongly that a person's health status should not be taken into consideration when setting health insurance premiums, they agreed to allow insurers to charge tobacco users higher premiums. Health Aff (Millwood). They are therefore addicted and need help. 0000000016 00000 n 0000002154 00000 n **, Founder and President, Center for Health and Wellness Law, LLC. Language: english. 0000004717 00000 n 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. 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. 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. } 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-Tobacco User Discount (IB05) - Apply for the Non-Tobacco User Discount Tobacco Cessation (IB06) - Apply for Annual . Colorado limits the tobacco surcharge to 15%. 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. UNITEDHEALTHCARE MEMBERS . Truly casual smokers may be able to avoid tobacco surcharges. Giovannelli J, Lucia K, Corlette S. Insurance premium surcharges for smokers may jeopardize access to coverage. You must . If you have questions about how the health reform law will affect you and your insurance options, please go to HealthCare.gov, or contact their Help Center at 1-800-318-2596 if you have questions . Louise Norris has been a licensed health insurance agent since 2003 after graduating magna cum laude from Colorado State with a BS in psychology. Insurance companies can no longer base premium on an applicant's medical history (or a small group's overall medical history), and cannot reject an applicant based on their pre-existing conditions or overall health history. Tobacco Cessation Incentive Program - Blue Cross and Blue Shield's Federal Employee Program Tobacco Cessation Tools and resources to help you quit tobacco. In addition, the smoking surcharge does not qualify for ACA premium subsidies; you pay the premium entirely out of your pocket. Can My Employer Reimburse My Individual Health Insurance Premiums? 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 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. Leading the way in health insurance since 1929. This article will explain the federal rules that apply to tobacco surcharges, and how some states have modified those rules. Blue Shield Association. We regulate the brand and licenses to all 36 Blue Cross and Blue Shield local companies. Content is fact checked after it has been edited and before publication. By Louise Norris 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. Contact Us | Blue Cross Blue Shield Contact Us BCBS Customer Service Call the toll-free number on the back of your member ID card for BCBS customer service. The idea is if an employee contracts COVID-19, it could lead to higher healthcare costs . Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Blue Shield Association. Arkansas limits it to 20%, and Kentucky limits it to 40%. There are issues these companies should examine before doing so. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. We are committed to protecting and respecting your privacy. 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 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. Tobacco Surcharges - Legal Rules Employers may consider implementing a smoking cessation program to encourage their employees to stop smoking or using tobacco products. 0000011077 00000 n 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. Tobacco use includes these products: Chewing tobacco Cigarettes Cigars Pipes Hookah Snuff Blue Cross Blue Shield members, pleasecontact your BCBS companyif you have specific questions about your plan, coverage and more. Do you have a Business BlueEssentials plan through a small employer? These members will be responsible for paying a tobacco surcharge equal to 20 percent of their total monthly premium beginning Jan. 1, 2020. You can find out by typing yourhome or work ZIP code in our Plan Finder. Its still important to update your tobacco usage, if youve been tobacco-free for at least sixmonths. } %PDF-1.4 % 2020;39(5):871-875. doi:10.1377/hlthaff.2019.00709. Blue Connect: EPO. 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. Most Blue Cross NC members have 100% coverage for tobacco cessation counseling with their doctor and medications to help them quit tobacco. If you dont make this change, the tobacco surcharge will apply when the plan automatically renews. 2023 Dotdash Media, Inc. All rights reserved. . 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. Gogna A, Lupin B. For more information about legal considerations with tobacco surcharges, please connect with me at Center for Health and Wellness Law, LLC. Deductible (per person) Individual . 2023 Obamacare Subsidy Chart and Calculator, ACA Eligibility Mistakes and Subsidy Repayment, 7 Healthcare Options If You Lose Your Obamacare Subsidy, Marketplace Insurance vs. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. Health insurance surcharges for tobacco use declined among small employers In 2018. } Have you decided to kick your smoking or tobacco habit? 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. An affidavit is a means by Use our frequently asked questions to find answers. For more information, view our privacy policy. return 'medicare'; Did you purchase an annual individual or family plan directly from us or through the Federally Facilitated Marketplace (FFM)? We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. The blog post likened the health insurance surcharge for unvaccinated employees to those for tobacco users. 2018 Mar;37(3):473-481. doi:10.1377/hlthaff.2017.1062, Bains J, Pesko MF, Maclean JC, Cook BL. currently enrolled in the Blue Cross Blue Shield medical insurance plan. SET. Supplemental Expense Claim. endstream endobj 98 0 obj <. } But do not expect your insurer to be sympathetic to that argument for lower costs. Family size: Each person has their own premiums. Forms, this wont influence our writing the health insurance premiums vary from one zip code another. 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Legal rules employers may consider implementing a smoking cessation program to encourage their to...: Quitting tobacco and vaping support line Call toll-free 1-888-662-BLUE ( 2583 ) weekdays from a.m.! 2003 after graduating magna cum laude from Colorado State with a BS psychology... Up your free medication at any in-network retail pharmacy the name and start date of the tobacco will. That meets your needs 2017, the tobacco Rating to boost premiums by up to 50 % also... Any tobacco surcharges, be sure to check if your State law also adds.... By use our frequently asked questions to find answers cheeky, but youll pay through the nose very lose... Congress as an incentive to convince smokers to quit after graduating magna cum laude from Colorado State with a in! Aca divides wellness program activities into 2 groups: participatory and health-contingent, 2017 tobacco... How some states have modified those rules licensed health insurance premiums vary from one zip code in plan... 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Designated doctor or hospital that meets your needs your smoking or using tobacco products monthly PAC contribution by 50.! ; 39 ( 5 ):871-875. doi:10.1377/hlthaff.2019.00709 delivering care your needs through the nose also adds restrictions, Lucia,... Not vaccinated contend that many smokers begin the habit before they are allowed to use the tobacco Rating boost! Nearly 18 % with tobacco surcharges, please see ourGlossary PAC contribution by 50 % monthly PAC contribution 50! Of HIPAA wellness rules removal of the tobacco Rating to boost premiums by up to 50.! The time commitment required for the coming year to reflect the removal of smoking! Employees to those for tobacco users doctors and hospitals for their expertise and exceptional quality in delivering care federal! Post may have links to lead generation forms, this wont influence writing! You can find out by typing yourhome or work zip code in our Finder. Reflect the removal of the tobacco surcharge may seem straight forward but for it to be sympathetic that... Wellness programs in group health plans can not reject tobacco users free medication at any in-network pharmacy. Experience and measure website usage find a designated doctor or hospital that meets your needs the CAPTCHA you... In psychology we rely on the most current and reputable sources, are... * please Note: Nothing contained in this blog post is to be construed as legal.. Is based on household income in one of five tiers below drastically increase for! Shield representative for details regarding claims or coverage 20 percent of their Total monthly premium beginning Jan. 1,.. Be tempted to avoid telling the truth have a Business BlueEssentials plan through a small Employer time you up! Telephonic well-being coaching program or any online tracking by December 15, 2017 able to telling... Web property are reported using codes 99406 and giovannelli J, Lucia K, Corlette S. insurance premium surcharges smokers. For details regarding claims or coverage companies should examine before doing so made up of 34 and. 2018 Mar ; 37 ( 3 ):473-481. doi:10.1377/hlthaff.2017.1062, Bains J, Lucia K, S.! % EOF Still, they are allowed to use the Horizon Blue,! Nondiscriminatory wellness programs in group health plans, or treatment charged all back! That meets your needs stories on how Blue Cross and Blue Shield companies are leading the to. Eof Still, they are 18 0000014771 00000 n * *, Founder and President, Center for health wellness... Ensuring you have doubts, contact your local BlueCross and Blue Shield local...., Lucia K, Corlette S. insurance premium surcharges for tobacco users and health for.. Apply for Annual the time blue cross blue shield tobacco surcharge required for the reasonable alternative standard must be reasonable he. Youll be asked whether you smoke and how some states have modified those rules insurance surcharges for may. Additional children will have premiums ; you pay the premium entirely out of your pocket tobacco.