Purdue Medical Plan Tobacco-User Additional Premium: Questions and Answers

Basic Information

• When did the tobacco-user additional premium go into effect?

  January 2012

• To whom does the additional premium apply?
  

  All faculty and non-graduate staff as well as their spouses covered by a Purdue employee medical plan who certify they have used tobacco in the last 12 months at the time of enrollment into the plan.

• How much is the additional premium?
  

  $1,000 per employee and covered spouse, per plan year. (2024) $1,250 per employee and covered spouse, per plan year. (2025)

• How will the additional premium be administered?
  

  The annual additional premium for you and your covered spouse will be divided by your number of annual Purdue pays; an equal amount will be taken from each of your pays throughout the calendar year.

• How will the additional premium appear on my pay stub?
  

  The tobacco-user additional premium is combined with the medical plan premium shown on your pay statement; it is not listed separately.

• How does Purdue define a "tobacco user"?
  

  A tobacco user is a person who has used tobacco in the past 12 months. "Tobacco" includes cigars, cigarettes, chewing tobacco, pipe tobacco or any other tobacco product. It also includes electronic cigarettes (vape pens and kits) which contain nicotine which is derived from tobacco.

• Is vaping (use of electronic cigarettes) considered "tobacco use" in terms of incurring the additional premium?
  

  Yes, because they contain nicotine, which is derived from tobacco. The health effects of using electronic cigarettes are currently unknown. Several studies regarding the long-term health effects of nicotine vapor, both inhaled directly and secondhand, are currently in progress. The FDA will be developing regulations on electronic cigarettes as tobacco products under the Family Smoking Prevention and Tobacco Control Act.

• I use the nicotine patch, does that count as tobacco use?
  

  No. Nicotine replacement therapy, such as the nicotine patch, nicotine gum, or nicotine lozenges, does not count as tobacco use.

• Are electronic cigarettes recognized as nicotine replacement therapy?
  

  No. A number of FDA-approved smoking cessation aids are available for tobacco users, depending on their dependence on nicotine. These include nicotine gum, nicotine transdermal patches, nicotine lozenges, nicotine inhalation products, nicotine nasal sprays, Chantix tabs, and Bupropion 150 mg SR/Zyban 150 mg.

• Why are tobacco users being charged more?
  

  Studies show that a tobacco user's annual medical costs are on average $1,700 higher than the costs of a non-tobacco user. The additional premium was set at $500 per year, per person to recover a portion of these additional costs.
  
  According to the Centers for Disease Control and Prevention, men and women who smoke have more lifetime medical expenses and are absent from work more days each year than those who do not smoke. In addition, smoking increases costly complications of pregnancy, such as pre-term delivery and low birth-weight infants.
  The state has identified the following statistics about what tobacco costs Indiana each year:

  • For every pack of cigarettes sold in Indiana, Hoosiers spend $7.57 in health care costs related to smoking.
  • Indiana residents' state and federal tax burden from smoking-caused expenditures is $566 per household.

  Annual smoking-related economic costs (including smoking-attributable medical expenditures and smoking-attributable neonatal medical expenditures) total $3,391 per smoker.

• Why are we focusing on tobacco?
  

  According to the National Institute on Drug Abuse:

  • Smoking harms nearly every organ in the body. It's been linked to cataracts and pneumonia, and it accounts for about one-third of all cancer deaths. The overall rates of death from cancer are twice as high among smokers as among nonsmokers.
  • Smoking has been linked to about 90 percent of all cases of lung cancer and is associated with many other cancers and lung diseases. It's also been well documented that smoking substantially increases the risk of heart disease, including stroke, heart attack, vascular disease and aneurysms.
  • All tobacco, including smokeless tobacco, contains nicotine, which is addictive. The amount of nicotine absorbed from smokeless tobacco is 3-4 times greater than that delivered by a cigarette, and while nicotine is absorbed more slowly from smokeless tobacco, more nicotine per dose is absorbed and stays in the bloodstream longer.
  • Chewing tobacco and snuff contain 28 carcinogens (cancer-causing agents). Smokeless tobacco increases the risk for cancer of the oral cavity, which can include cancer of the lip, tongue, cheeks, gums, and the floor and roof of the mouth. Other effects include oral leukoplakia (white mouth lesions that can become cancerous), gum disease, and gum recession (when the gum pulls away from the teeth).
• How can Purdue charge me more for being a tobacco user?
  

  The wellness program exemption from HIPAA's nondiscrimination rules allows employers to offer health plan-related financial incentives to discourage tobacco use as long as the total reward is limited, promotes good health or prevents disease, and is available to all similarly situated individuals.

• Will other health-related additional premiums be considered in the future for things like obesity, alcohol use and so forth?
  

  Substantial research links tobacco use to increased medical costs. The University will continue to evaluate medical research regarding other health factors as we develop future plan design recommendations. Our ultimate goal is to build a culture of health and wellness in which employees choose to become healthier.

Avoiding/Waiving the Additional Premium

• How can I avoid the additional premium?
  

  2024 Additional Premium ($1,000); 2025 Additional Premium ($1,250)

  For non-tobacco users:
  To avoid the additional premium, you must certify during your benefits enrollment and subsequent annual open enrollment that you have not used tobacco in the 12 months immediately prior to completing your enrollment.

  For tobacco users:
  To waive the additional premium, you have the following options:

  Complete an approved tobacco cessation program
  You may begin a tobacco cessation program at any time, but it must conclude after January 1 of each year in order to apply toward your premiums that year. Submit your certificate of completion to HR by March 31 of each year to retroactively reduce your impacted premiums for that entire plan year (a refund will apply, if applicable). Certificates received after March 31 will reduce your premiums going forward only

  Become tobacco-free for 12 months
  If you do not want to complete a tobacco cessation program (e.g., you have already quit), you may submit Tobacco User Certification Form at the point where you have not used tobacco in the last 12 months. Submit the form by March 31 each year to retroactively reduce your impacted premiums for that entire plan year (a refund will apply, if applicable). Certificates received after March 31 will reduce your premiums going forward only. Note: You do not have to enter a recipient to email at the bottom of the form; it will automatically be routed to Human Resources.

• What if I don't certify my tobacco user status during my initial enrollment or recertify during the annual open enrollment period in the fall?
  

  If you do not certify during your initial enrollment when hired or newly eligible for benefits or during the annual open enrollment period in the fall, you (and your covered spouse, if applicable) will default to tobacco user status.

• What if employees certify that they are not tobacco users when, in fact, they are?
  

  When you certify your tobacco-user status, you attest that you are telling the truth. If it is later discovered that you made a false statement, you will be subject to disciplinary action, which may affect your employment.

• If I complete an approved tobacco cessation program or become tobacco-free for 12 months during the calendar year, will Purdue refund the tobacco-user additional premium that's already been taken from my pay?
  

  Yes, only if you submit your certificate of completion to Human Resources by March 31st. After March 31st, the additional premium will be waived for the remainder of the plan year only.

• How do I complete an approved tobacco cessation program?
  

  Information about approved tobacco cessation programs is available through Human Resources Benefits.

• How much will I pay to participate in an approved tobacco cessation program?
  

  The approved tobacco cessation programs made available by Purdue are at no charge to you or your covered spouse. Purdue provides the approved programs as a benefit to you.

• Are there other options for tobacco cessation programs?
  

  Community Alternative: If you take part in a tobacco cessation program through other campus resources, hospitals or community organizations, you may qualify for waiver of the tobacco-user additional premium, depending on the specifics of the offering. Before taking part, contact HR Service Center to review the details of the offerings and find out if completion of the program will qualify you for the additional premium waiver. If the program qualifies, HR Service Center will provide you with a Community Alternative form that you must have signed by the community program's representative when you have finished the program. Please note, there may be costs to you for community programs.
  
  Medical Alternative: If you are unable to participate in a traditional program due to a medical condition, contact Human Resources to develop an alternative way to qualify for waiver of the tobacco-user additional premium.

• I only use tobacco occasionally. Do I certify as a tobacco user?

  Yes. You are considered a tobacco user until you have been 12 months tobacco-free.

• If I complete an approved tobacco cessation program, will that also qualify me for non-tobacco user rates on my Purdue employee term life insurance through Minnesota Life as well as my critical illness?
  

  Yes. Premiums will be reduced to reflect the non-tobacco user rate for the payroll period following the submission of a completion letter or certificate to Human Resources upon the completion of the program.