Q&A: Tobacco Policies
All people enrolled in State of Texas health plans must certify their tobacco-use status—even if you don’t use tobacco.
All people enrolled in Texas Employees Group Benefits Program (GBP) health insurance plans must certify their status as tobacco users or non-users. Adult GBP participants who do not certify their tobacco-use status will be charged the monthly Tobacco User Premium—even if they don’t use tobacco.
You must certify your status as a tobacco user or non-user as well as the status of any of your dependents enrolled in a state health plan—even if you and your covered dependents don’t use tobacco. Additionally, state law offers tobacco users in the GBP coverage for prescription drugs to help them quit tobacco. It also authorizes charging higher premiums for people who continue to use tobacco.
1. What is considered a tobacco product?
Tobacco products are cigarettes, cigars, pipe tobacco, chewing tobacco, snuff, dip, or any other product that contains tobacco. Electronic or e-cigarettes that do not contain tobacco and are designed expressly for smoking cessation are not considered tobacco products. Nicotine replacement products, such as gum and patches, are not considered tobacco products. To certify that you do not use tobacco, you must not have used a tobacco product more than four times in the previous three months.
If you or any of your dependents enrolled in a state health plan use tobacco, you will have to pay the higher premium.
2. How do I certify?
Sign in to your account and complete the certification steps. You can also call ERS toll-free at (866) 399-6908 to certify.
3. Who will pay an additional $30 premium each month (up to $90 per household)?
- Certified tobacco users of any age—adults and minors—will be charged.
- Only adults who fail to certify will be charged the additional premium. Those under 18 who are not certified will not be charged.
- The charge for covered children—adults or minors—who use tobacco is the same, no matter how many children in the household use tobacco.
- The charge for covered adult children who fail to certify is the same, no matter how many adult children in the household fail to certify.
See the payment chart for more information.
4. How much will tobacco users or people who fail to certify pay?
The monthly Tobacco User Premium is $30 per tobacco user of any age or $30 per adult (age 18 and older) who fails to certify. You will pay $30, $60, or $90 more each month in additional health insurance premiums, depending on how many tobacco users or adults who fail to certify you cover. The maximum additional premium each family could pay is $90 a month. The charge for a child is the same regardless of how many children in the household use tobacco. For example:
- In the Smith family, the member and her husband don’t use tobacco. Their 19-year-old daughter and their 17-year-old son do. Mrs. Smith certified herself and her husband as non-tobacco users, and certified both children as tobacco users. The family pays a monthly Tobacco User Premium of $30.
- In the Ramirez family, the member uses tobacco, but his wife and children do not. Mr. Ramirez certified himself as a tobacco user and certified the rest of his family as non-tobacco users. The Ramirez family pays a monthly Tobacco User Premium of $30.
- No one in the Dawson family uses tobacco. Ms. Dawson did not complete the tobacco certifications for herself and her three children, who are ages 21, 18, and 14. The Dawson family pays a monthly Tobacco User Premium of $60.
5. How do I get help if I want to quit using tobacco?
Your GBP health plan offers tobacco cessation resources, including counseling. Contact your health plan for more information. You can also see if your employer offers a worksite wellness program.
6. What if I quit or someone I cover quits?
If you or your covered dependents have not used tobacco products more than four times in the previous three months, you can change the certifications to non-tobacco users. Once you update the certifications, the monthly Tobacco User Premiums will end on the first day of the next month.
7. Do our GBP health plans cover prescription drugs that can help me quit using tobacco?
Yes. Certain prescription tobacco cessation drugs—Zyban; its generic, bupropion; and Chantix—are usually covered. Contact your doctor to see if they are right for you.
|HealthSelect copays for tobacco cessation drugs:
||Difference between Zyban
and generic (Bupropion)
|Note: The plan's annual deductible of $50 will apply to these claims at mail and retail.
8. What if my doctor says I can’t quit?
If you or a covered dependent have an uncontrolled health factor, such as nicotine addiction, you should submit a physician affidavit. You can submit a physician affidavit anytime—the higher premiums will be waived at the start of the next month after the physician affidavit is approved. New employees have 90 days to submit an affidavit.
9. What if I start using tobacco again after certifying as a non-tobacco user?
Change your certification status immediately or you risk a penalty, fraud investigation, or termination from the GBP health plans.
10. What if I know someone who certified as a non-tobacco user but actually uses tobacco?
If you have witnessed someone insured through the GBP, including a dependent, using a tobacco product five or more times within the past three consecutive months, please report this information to ERS.
11. How can I get help if I want to quit using tobacco?
Your doctor can help. Your health plan offers tobacco cessation resources, including counseling; contact your health plan for more information. You also can check to see if your employer offers a worksite wellness program.
12. Why did the Legislature enact the Tobacco User Premium?
State officials are concerned about Texans’ health and the cost poor health has on health insurance and the state budget. They passed the measure as an incentive to help people quit using tobacco and live longer, healthier lives.
13. Why do people who don’t use tobacco have to certify?
As of May 31, 2013—more than one year after the Tobacco User Premium went into effect (on January 1, 2012)—fewer than 5.5% of GBP health insurance participants had certified as tobacco users. The National Institute on Drug Abuse estimates that more than 20% of people in the United States use tobacco. This means that probably not everyone in the GBP who uses tobacco has certified as a tobacco user. By asking all GBP participants to certify, we expect that more tobacco users who haven’t certified yet will do so.
14. Who is considered a tobacco user?
In the GBP, a person who has used tobacco five or more times in the previous three months is considered a tobacco user. In order to certify as a non-user, you must not have used a tobacco product more than four times in the previous three months.
15. What about nicotine replacement therapy?
Nicotine replacement products like gum and patches are not considered tobacco products.
16. I don’t use tobacco products and my dependents don’t use them. What do I need to do?
Even if you and your covered family members don’t use tobacco, you must certify yourself and them as non-users. If you do not certify yourself and your covered dependents as non-users, beginning September 1, 2013, you will be charged $30 per month for each covered adult in your household who isn’t certified (up to $90 per month) until you do certify all covered household members.
17. What happens if I use tobacco but I don’t certify that I do?
You will need to change your certification status or risk a penalty, fraud investigation, or termination from the GBP health plans. Any member caught falsifying information will be charged the premium amount owed for the entire time the member was employed by the State during the period the increased premiums for tobacco use were in effect. For example, someone who was caught using tobacco in March 2012 would owe $30 each for January, February, and March 2012 and all months thereafter until that person is no longer a tobacco user.
18. I just discovered that one of my dependents uses tobacco. What do I do?
You will need to certify that he or she is a tobacco user immediately. The additional premium will start at the first of the month following the certification.
19. Is this kind of additional premium illegal?
No. Many employers have enacted similar, or even stricter, rules. These rules have survived numerous legal challenges.
20. How did ERS inform members about the requirement to certify tobacco use or non-use?
Between April 24 and September 30, 2013, ERS reached out to members and benefits coordinators/HR representatives through 38 communications. Every member enrolled in a Texas Employees Group Benefits Program (GBP) health plan received information in his or her Annual Enrollment packet. In addition, all members who had not certified their and/or their dependents’ tobacco use or non-use by the end of Annual Enrollment received postcards and automated phone calls asking them to certify before the August 31 deadline. ERS sent an additional letter in September to members who had not certified by the deadline. See a full list of the communications activities here.