SHBP Plan Surcharges

Tobacco Surcharge Policy and Instructions

Members who were assessed the tobacco surcharge in 2012 and who failed to answer the surcharge question for 2013 will continue to be assessed the surcharge for 2013.  

All tobacco users have the opportunity to have their tobacco surcharge removed by completing the wellness requirements in the Tobacco User Policy (shown below) through their health plan vendor (Cigna or UnitedHealthcare). Members who are non-tobacco users and who complete the requirements shown in the Non-Tobacco User Policy (shown below) will have the tobacco surcharge removed from future premium payments.

For further details, please see section of your SPD that describes the tobacco surcharge and review the Active and Retiree Non-Tobacco User Policies below.

Note:  To have the tobacco surcharge removed from future premium payments, please refer to the Tobacco Surcharge Policy information and the Health and Wellness Program instructions below.

2013
Active Employees	Retirees
2013 Active Employee Non-Tobacco User Affidavit	2013 Retiree Non-Tobacco User Affidavit
2013 Active Employee Non-Tobacco Users Policy	2013 Retiree Non-Tobacco Users Policy
2013 Active Employee Tobacco Cessation Affidavit Form	2013 Retiree Tobacco Cessation Affidavit Form
2013 Active Employee Tobacco Cessation Policy	2013 Retiree Tobacco Cessation Policy

  Instructions for Health and Wellness Programs