Q&A: Tobacco Policies

A new state law offers tobacco users in the Texas Employees Group Benefits Program (GBP) coverage for prescription drugs to help them quit tobacco starting September 1, 2011. It also authorizes charging higher premiums for people who continue to use tobacco starting January 1, 2012.

1. Why did the Legislature make this change?

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.

2. Who is considered a tobacco user?

In order to certify that you do not use tobacco, you must not have used a tobacco product more than five times in the previous three months. 

3. What is considered a tobacco product? 

A tobacco product is defined as cigarettes, cigars, pipe tobacco, chewing tobacco, snuff, dip, or any other product that contains tobacco. It does not include an electronic cigarette or e-cigarette that does not contain tobacco and is designed expressly for smoking cessation. 

4. What about nicotine replacement therapy? 

Nicotine replacement products like gum and patches are not considered tobacco products. 

5. How do I certify that I’m a tobacco user, or that someone I cover is a tobacco user?

You can certify that you and any covered dependents use tobacco by signing in to your account and completing the certification. You can also call ERS toll-free at (866) 399-6908. If you or anyone you cover uses tobacco, you will have to pay the higher premium. 

6. How much will tobacco users pay?

The additional monthly premium will be based on three tiers: Member, Spouse, and Child. The maximum additional premium is $90 a month.

7. What if I quit using tobacco, or if someone I cover quits? 

You can change your designation or the designation of anyone you cover in a health plan if you certify that the member has stopped using tobacco for three consecutive months. You must meet certain requirements, including completing an affidavit attesting to the member’s new tobacco-free status. Once you have met certain requirements, the additional premiums will end on the first day of the next month, or as soon as administratively possible. 

8. Does our health insurance plan cover prescription drugs to help me stop smoking? 

Yes. Effective September 1, 2011, certain prescription tobacco cessation drugs—Zyban, its generic Bupropion, and Chantix—are covered. Contact your doctor to see if they are right for you.

9. I don’t use tobacco products and my dependents don’t use them. What do I need to do? 

Even if you don’t use tobacco and don’t cover family members who use tobacco, you must certify your status as a non-tobacco user, as well as the status of any dependents who are enrolled in a state health plan. 

10. 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 health insurance. 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 caught using tobacco in March 2012 will owe $30 each for January, February, March, and all months thereafter until that person is no longer a tobacco user. 

11. 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. 

12. What if my doctor says I can’t quit? 

A tobacco user diagnosed as having an uncontrolled health factor, such as nicotine addiction, should submit a physician affidavit. New employees will have 31 days to submit a physician affidavit. You can submit physician affidavits anytime throughout the year—the higher premiums will be waived at the start of the next month, or as soon as administratively possible. 

13. Where do I certify that I use tobacco, or that one or more of my dependents use tobacco?

You can certify tobacco use online, or contact ERS by telephone at (866) 399-6908. There will be a link to a special Tobacco Designation page at www.ers.state.tx.us. You will have to sign in to your account to make the designation. 

14. Is this kind of additional premium illegal?

No, many employers have enacted similar, or even more strict rules. These rules have survived numerous legal challenges.