The Official Portal for the State of Georgia

Tobacco Surcharges Policies and Instructions

Note: members that failed to answer the surcharge questions, should refer to the Non-Tobacco user Policy and Affidavit

Active Members
Cigna Tobacco Cessation Flyer              UHC Tobacco Cessation Flyer

2012

2011

Retirees

2012

2011

Instructions for Health and Wellness Programs


2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

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2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->
2010 Non-Tobacco Use

 Non-Tobacco Users Policy - Updated 11/12/09
 Non-Tobacco Users Affidavit Form - Updated 11/12/09

To view PDF documents you will need the free Acrobat Reader application.

-->