Tobacco Surcharge Frequently Asked Questions 2017

Tobacco Surcharge Frequently Asked Questions 2017 Why did Advocate implement a Tobacco Surcharge? To support a culture of health and wellness among associates. To set an example as a leader in healthcare and encourage associates to make healthy choices. Encouraging associates to be tobacco-free is a proactive way to help manage health care costs. What is the impact of tobacco use on health and health care costs? Tobacco use remains the single largest preventable cause of disease and premature death in the nation. In fact, tobacco causes more deaths than AIDS, alcohol abuse, automobile accidents, illegal drugs, fires, homicide, and suicide combined. Using tobacco also contributes to chronic and serious diseases, which results in increased health care costs. Average Annual Health Care Costs* Tobacco-Free Male $3,600 $4,800 Tobacco User Female $5,000 $7,000 $9,000 (expectant mother) *Based on 2012 study by Leif Associates, Inc., a health care actuarial consulting firm. What is the 2017 tobacco surcharge? If you use tobacco, you will pay a surcharge for your medical plan coverage beginning with pay period 1 of 2017. The surcharge applies to associates and covered spouses/partners. Associate Covered spouse/partner The surcharge will automatically be applied to your medical plan deductions for 2017 unless you take action to certify you are tobacco-free. What is the 2018 tobacco surcharge? Associate Covered spouse/partner Do I need to get a screening to avoid the 2017 surcharge? If you previously screened tobacco-free prior to 12/2/16, you will only need to certify through an electronic affidavit that you continue to be tobacco-free to avoid the surcharge in 2018. You will complete the electronic affidavit as part of the 2017 Health Risk Questionnaire (HRQ). If you screened after 12/2/16, you would have signed a paper affidavit at your screening to certify your tobacco status. How to access your Healthe Rewards page where the HRQ/Tobacco Affidavit is located: Associates: Log in to advocatebenefits.com > Health & Welfare Benefits>Healthe You> HRQ icon Covered Spouses/Partners: Go to advocatebenefits.com > Access Healthe You> Log in to Healthe Rewards Account>HRQ icon What is considered a tobacco product? Cigarettes, cigars, cigarillos, pipes, chewing tobacco, snuff, dip, loose tobacco smoked via pipe or hookah, nicotine replacement therapies (i.e. gum, patch lozenges), e-cigarettes and any other tobacco product, regardless of the frequency or method of use. 17-07 11.2016

If I have a covered spouse/partner do both of us have to be tobacco-free to avoid the Tobacco Surcharge? The tobacco surcharge applies to each participant associate and covered spouse/partner. Important: Associates and covered spouses/partners who have previously screened tobacco-free prior to 12/2/16 each need to complete the electronic HRQ/Tobacco Affidavit each year to avoid the surcharge. The surcharge for each participant will automatically be applied to your medical plan deductions unless you complete the HRQ/Tobacco Affidavit or screen tobacco-free if you have not previously done so -- no exceptions. Where does the money from the Tobacco Surcharge go? Into a health care claims account to cover additional health care claims incurred by tobacco users. How do I get the 2017 Tobacco Surcharge removed? If you have never screened tobacco-free Complete a tobacco screening and sign an affidavit. You must be tobacco-free for at least the prior six months. Call 1.800.937.5717, 8 am-8 pm, M-F, to schedule. If you screened tobacco-free prior to 12/2/16 Complete the electronic 2017 Tobacco Affidavit to certify that you continue to be tobacco-free. The 2017 affidavit will be available on your Healthe Rewards Page after 1/2/17 for participants who did not complete the 2017 affidavit by the 12/2/16 deadline. The affidavit appears when you complete the 2017 Health Risk Questionnaire (HRQ). Select the 2017 HRQ icon to get started. Who should get a tobacco screening in 2017? New associates who elect medical benefits; their covered spouse/partner must screen-tobacco free as well. You must screen tobacco-free within 45 days of the associate s benefits enrollment date to avoid the tobacco surcharge. Associates (or a covered spouse/partner) who have not previously screened-tobacco free. Associates (or a covered spouse/partner) who have quit tobacco for at least six months and want to remove the tobacco surcharge prospectively. Associates who elect medical benefits during 2017 due to a status change or qualified event. How do I schedule a tobacco screening? Schedule online on your Healthe Rewards Page or call the Healthe You Solution Center at 1.800.937.5717, 8 am to 8 pm, M-F. Associates: Log in to advocatebenefits.com > Health & Welfare Benefits>Healthe You>Schedule Screening icon OR Go to advocatebenefits.com> Access Healthe You >Log in to Healthe Rewards Account>Schedule Screening icon Covered Spouses/Partners: Go to advocatebenefits.com> Access Healthe You >Log in to Healthe Rewards Account>Schedule Screening icon Participants who complete the Healthe Breathe ppogram may receive reimbursement for the six months they participate in the program and may have the surcharge removed for the remainder of the year, (if you start the program before July 1 of each year). See page 3 for details on Healthe Breathe. 2

Can I avoid the surcharge if I am trying to quit and using nicotine replacement therapies (NRTs)? No, you cannot avoid the surcharge if you are trying to quit and using NRTs. NRTs patch, gum, nasal spray, inhalers or lozenges continue to deliver nicotine to the body, which is harmful to your health. While the dosage is less, nicotine use in any form can impact the cardiovascular system, and cause inflammation in the body leading to health risks. To avoid the tobacco surcharge entirely, you must be tobacco-free for six months, and this includes no use of NRTs for six months prior to your screening date. What support to quit tobacco does Advocate offer? Advocate offers the Healthe Breathe tobacco cessation program to help you quit tobacco. Access a flier about the program at advocatebenefits.com>benefits Information>Healthe You. Call the Healthe You Solution Center at 1.800.937.5717, 8 am-8 pm, M-F, to learn more and to enroll If I enroll in the Healthe Breathe Program can I avoid the tobacco surcharge? As noted in the previous question, to have the surcharge completely removed you must successfully quit using tobacco for at least six months and screen tobacco-free. Each year after screening tobacco-free you must complete an electronic tobacco affidavit located at the end of your Health Risk Questionnaire (HRQ) to avoid the surcharge for the upcoming year. The HRQ/Tobacco Affidavit can be found on your Healthe Rewards Page. However, participants in the Healthe Breathe Program will be reimbursed for the tobacco surcharges they incurred during the 6 months they were participating in the program at the end of their program completion month (rolling calendar year). Participants who complete the program will also have the surcharge removed for the remainder of the year (if you start the program before July 1 of each year). The surcharge will be reimbursed from the date you enroll in the Healthe Breathe Program. o Example: Participant enrolls January 1, 2017 and completes the program July 1, 2017. Reimbursement would be for the six-month period of January 1 through July 1, and the surcharge would then be removed through December 31, 2017. In other words, this participant avoids the tobacco surcharge for the entire year because he/she enrolled in the Healthe Breathe Program at the start of the year. o Example: Participant enrolls April 1, 2017 and completes the program October 1, 2017. Reimbursement would be for the six-month period of April 1, 2017 through October 1, 2017, and the surcharge would then be removed through December 31, 2017. This participant avoids the tobacco surcharge for a portion of the year because he/she enrolled in the Healthe Breathe Program mid-year. Participants must complete the Healthe Breathe Program each year if they have not fully quit tobacco to be eligible for the surcharge reimbursement. Participants must have one enrollment date per year and complete the program to have the surcharge removed for the remainder of that year. 3

o Example: Participant enrolls September 1, 2017 and completes the six-month program February 1, 2018, but has not been tobacco-free for at least six months. [Participant would receive reimbursement for the surcharge for the six-month period of September 1, 2017 through February 1, 2018. However, the Participant would not have the surcharge removed for the remainder of 2018.] The Participant would need to enroll and complete the Healthe Breathe Program again in 2018 to receive a reimbursement for a six-month period during the 2018 plan year and have the surcharge removed for the remainder of 2018. Who can participate in the Healthe Breathe Program? Associates and covered spouses/partners enrolled in Advocate medical benefits. Benefits- eligible associates not participating in Advocate medical benefits can enroll in the telephonic coaching component of the program. What if I miss a coaching call? The Healthe Breathe Program includes two 15-minute coaching calls per month (two weeks apart). Program participants who miss a call must contact the Healthe You Solution Center no later than 3 business days after their scheduled call to reschedule. Failure to call back within 3 business days after a missed call will result in disqualification from the Healthe Breathe Program. Appeals will not be accepted for the Healthe Breathe Program. What if it is medically inadvisable for me to quit tobacco? If it is unreasonably difficult due to a medical condition for you to achieve tobacco-free status, or if it is medically inadvisable for you to attempt to become tobacco-free, you may call the Healthe You Solution Center at 1.800.937.5717 to request a medical waiver. To obtain a waiver, you will need to provide verification, such as a statement from your physician, that a health condition makes it unreasonably difficult or medically inadvisable for you to satisfy or attempt to satisfy the tobacco-free standard. In addition, you may be required to complete an alternative program in order to receive a waiver and avoid the tobacco surcharge. If you obtain a medical waiver (including completion of any alternative required in connection with the medical waiver), you may avoid the tobacco surcharge entirely. [For the remainder of the current plan year] Why do I need to sign an affidavit? Signing the affidavit is required each year so you understand the guidelines for the Tobacco Surcharge. By signing the affidavit, you certify you have been tobacco-free at least six months. You also acknowledge that if you start using tobacco during the year that you will notify Advocate and that a surcharge will be applied. What do I need to do before the screening? Don t eat or drink anything other than water. But do take any medications prescribed by your physician. For at least 10 minutes before the tobacco screening, you may not place anything in your mouth including food, drink or gum. What if I quit tobacco or plan to quit in 2017? Can I get the surcharge removed? You will be able to rescreen after being tobacco-free for six months. If you screen tobacco-free and sign the affidavit that you have not used tobacco for six months, you can have the surcharge removed prospectively. 4

What nicotine replacement therapies (NRTs) are available to participants? Associates and covered spouses/partners enrolled in Advocate medical benefits or benefits-eligible associates not participating in Advocate medical benefits are eligible to receive gum, patch and lozenges. How much will the NRTs cost me? Associates and covered spouses/partners enrolled in Advocate medical benefits, or benefits-eligible associates not participating in Advocate medical benefits, may obtain up to a six month supply of tobacco cessation products per rolling calendar year with zero copay on generics. Prescriptions from the participant s physician are required for over the counter (OTC) products. OTC products can be filled by retail or mail order pharmacy. Coverage is for generic products only with the exception of branded products for which a generic is not yet available. How do I decide which NRT is best for me to use? Participants need to consult with their physician as to which NRT is best for them. Coaches do not help in this decision process, this decision needs to be between a participant and their physician. How do participants receive NRTs? Participants will need to work with their physician to decide which NRT is best for them. The physician will need to write a prescription for OTC products. The participant can then fill the prescription by retail or mail order pharmacy. Why do I have to pay a surcharge if my covered spouse/partner is a smoker and I m not? Your covered spouse/partner is a participant in the medical plan and their tobacco use ultimately causes increased health care costs. Tobacco is considered the leading preventable risk factor for illness and disease and research shows that tobacco users spend an average of 30% more in annual health care costs compared to non-tobacco-users.* *Source: The Business Case for Coverage of Tobacco Cessation 2012 Can I use a doctor s statement versus having a tobacco screening to certify that I am tobacco-free? No, we require a tobacco screening for all participants to ensure consistency in the program. Do other employers have tobacco surcharges? Is it legal? A number of employers, including many in the Chicagoland area, have already implemented tobacco surcharges. In fact, Towers Watson s annual survey of large employers, National Business Group on Health Best Practices in Health Care Employer Survey, found that 44% of employers surveyed were using surcharges for tobacco users in 2015. To meet federal guidelines, a tobacco surcharge must promote good health and prevention of disease; participants must be given a chance to avoid the tobacco surcharge at least once per year; and upon request, an individual must be provided with an alternative option which the individual can satisfy in order to avoid the tobacco surcharge. What happens with the information and results obtained from my tobacco screening? Protecting your confidentiality and privacy is our top priority. All personal health information and screening results that are either created or used by the Healthe You initiative and for the tobacco screening are HIPAA compliant. This includes tobacco screening results. No one else will have access to your personal health information. 5