Why did the UT System implement this Tobacco Premium Program?
UT System cares about the health and well-being of its members. The Living Well wellness program provides a variety of programs, tools, and resources, to promote a culture of wellness and to enable employees, retirees and dependents to take charge of their health and develop their own personal wellness program.
The use of tobacco is one of the leading preventable health risks worldwide, and the use of tobacco is inconsistent with the culture of wellness. 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.
This Tobacco Premium Program was implemented independently of the UT institutions who have adopted a Tobacco-Free Policy on their campus. The Tobacco Premium Program is a component of the UT SELECT and UT CARE Medical plans, while the deciding to adopt a Tobacco-Free Policy is an institutional decision.
How much will tobacco users pay?
Members enrolled in the UT SELECT or UT CARE Medical plan pay a monthly premium surcharge of $30 per tobacco user per month. The Tobacco Premium Program will be added to the regular UT SELECT or UT CARE premium that is deducted from your paycheck.
Premium surcharges are based on three categories: Member $30 per month; Spouse $30 per month, and Child(ren) $30 per month. The premium surcharge for dependent children is $30 regardless of how many covered dependent children use tobacco. The maximum premium surcharge is $90 per family per month.
Who is considered a tobacco user?
A tobacco user is a person enrolled in the UT SELECT or UT CARE Medical plan, age 16 and above, who has used tobacco products within the past sixty (60) days.
What is included in the definition of tobacco products under the Tobacco Premium Program?
All types of tobacco products are included as part of the Tobacco Premium Program, including, but not limited to: cigarettes, cigars, pipes, all forms of smokeless tobacco (chewing tobacco, snuff, dip, or any other product that contains tobacco), clove cigarettes and any other smoking devices that use tobacco such as hookahs. E-cigarettes, which contain nicotine, are also included under the tobacco premium program.
Is nicotine replacement therapy included in the definition of tobacco products?
No. The Food and Drug Administration (FDA) has approved a variety of smoking cessation products. These include prescription medicines and over-the-counter (OTC) products such as skin patches, lozenges, and gum. Smoking cessation products are regulated through the FDA's Center for Drug Evaluation and Research, which ensures that the products are effective and that their benefits outweigh any known associated risks. Nicotine replacement products like gum and patches are not considered tobacco products for purposes of the Tobacco Premium Program.
How can the UT SELECT Medical plan help me quit using tobacco?
The UT System is committed to helping tobacco users quit by offering our UT SELECT and UT CARE covered members Smoking/Tobacco Cessation Programs, Pharmaceutical Therapy, and Nicotine Replacement Therapy (NRT) at no cost to the member. Learn more about programs available in the Living Well section of our website.
Does our health insurance plan cover prescription drugs to help me stop smoking?
Yes. The Prescription Drug plan for UT SELECT and UT CARE covers the following medications at a $0 copayment when they are used for prevention and/or part of a cessation program. To receive these medications at a $0 copayment, you must have a physician's prescription for the product, and it must be dispensed by a participating mail or retail pharmacy.
- Nicotrol NS: 90-day supply in any 365-day period.
- Nicotrol Inhaler: 90-day supply in any 365-day period.
- Zyban: 90-day supply in any 365-day period.
- Nicorette Gum /Lozenge: 90-day supply in any 365-day period.
- Nicotine Transdermal System: 90-day supply in any 365-day period.
- Chantix: 180-days supply in any 365-day period.
- Smoking Cessation Counseling
- Smoking Cessation Treatment
- Smoking Cessation Classes, non-physician
- Smoking and Tobacco Use Cessation Counseling
- Smoking and Tobacco Cessation, Intensive
The Regents Rules of The University of Texas System and all System institutions' policies provide that System employees may be disciplined for failure to comply with System policies. The UT SELECT and UT CARE plan requirements are official policies of The University of Texas System. An employee who has been found to have violated the plan requirements by falsely certifying his or her tobacco usage can be subject to sanctions under the employing institution's disciplinary rules that may range from a reprimand to termination of employment. Disciplinary action will be determined on a case-by-case basis. In addition, a plan member who intentionally fails to declare tobacco use to receive a reduced premium rate may be requested to repay premium discounts wrongfully obtained through misrepresentation.
You must make any changes regarding your tobacco usage and that of any covered dependents by signing into your benefits account on the My UT Benefits website, accessed at Managing your UT Benefits. You may also make a change by completing and signing the declaration form and submitting it to your institution's HR or Benefits Office. Any change in the premium surcharge(s) associated with a tobacco user declaration will start the first of the month following the declaration.
A tobacco user who has been diagnosed with an uncontrolled health factor and whose physician advises against stopping the use of tobacco should submit a statement from their treating physician. Tobacco users who qualify under this provision will no longer be charged the tobacco premium beginning the first of the month following submission of the Physician Statement. This Physician Statement can be submitted anytime during the year. Submit the completed and signed form to your institution's Benefits Office. A member is responsible to submit a Physician Statement every plan year to avoid charges of the tobacco premium program.
All funds generated by the Tobacco Premium Program will be used to support on‐going health and wellness programs and initiatives within UT System.
Could a member with a valid prescription for Nicotine Replacement Therapy (Nicotine Transdermal System or patches) receive these over-the-counter Nicotine Replacement Therapy for the 90-day supply in any 365 period at no cost?
Yes, they can receive a 90-day supply of over-the-counter Nicotine Replacement Therapy in any 365 period at no cost as long as they have a valid prescription and it's presented to the Pharmacist.
I understand that the NRT is covered at 100% with a prescription. However, is the doctor's visit to get the prescription covered at 100%? If so, how would it need to be coded?
If the provider bills one of the following services only (with no additional office visit charge) and with a preventive diagnosis based on preventive services covered Under the Affordable Care Act, then the services would be covered at 100% of the allowed in-network.
Where and how do I declare that I use tobacco, or that one or more of my dependents use tobacco?
During Annual Enrollment (July 15-July 31), you must declare whether you and/or any of your covered dependents use tobacco by signing into your benefits account on the My UT Benefits website, accessed at Managing your UT Benefits.
At any time of the year, you can make any changes regarding your tobacco usage and that of any covered dependents by signing into your benefits account on the My UT Benefits website, accessed at Managing your UT Benefits. You may also make a mid-year change by completing and signing the declaration form and submitting it to your institution's HR or Benefits Office.
Any change in the premium surcharge(s) associated with a tobacco user declaration will start the first of the month following the declaration.
I don't use tobacco products and my dependents don't use tobacco products. What do I need to do?
During Annual Enrollment (July 15-July 31) you should provide a declaration that you and any covered dependents do not use tobacco by signing into your benefits account on the My UT Benefits website, accessed at Managing your UT Benefits.
At any time of the year, you can make any changes regarding your tobacco usage and that of any covered dependents by signing into your benefits account on the My UT Benefits website, accessed at Managing your UT Benefits. You may also make a mid-year change by completing and signing the declaration form and submitting it to your institution's HR or Benefits Office.
Any change in the premium surcharge(s) associated with a tobacco user declaration will start the first of the month following the declaration.
I just discovered that one of my dependents uses tobacco. What do I do?
You must update your family's tobacco usage information by signing into your benefits account on the My UT Benefits website, accessed at Managing your UT Benefits. You may also make a mid-year change by completing and signing the declaration form and submitting it to your institution's HR or Benefits Office.
Any change in the premium surcharge(s) associated with a tobacco user declaration will start the first of the month following the declaration.
Who will be told about my status as a tobacco user? Will my HR office or supervisors be able to access my TPP Program records? This seems like a violation of my privacy.
The Tobacco Premium Program is part of the UT SELECT and UT CARE Medical plans offered by UT System. Both of these plans are subject to HIPAA rules and regulations. Therefore, all records concerning a plan participant's status as a tobacco user, including the declaration form and any physician's statement or even the status of a particular participant as a tobacco user or non-tobacco user are confidential medical plan records protected by the UT System Administration HIPAA Privacy Policies, as well as Texas Government Code Section 2054.1125, in the same way, that UT SELECT and UT CARE plan participant's enrollment data and other plan records are. You can find more information about the UT System Administrations Privacy Policies in the HIPAA section of this website.
Your UT SELECT and UT CARE records cannot be accessed or used for any purpose other than providing the information to the plan. Your UT SELECT and UT CARE records cannot be used by UT System or the plan or its vendors for any purpose other than those outlined in the UT System Notice of Privacy Practices. If you believe that a UT System employee and or a UT System medical plan vendor has shared your confidential information or it has been the subject of unauthorized access in violation of the UT System Administrations Privacy Policies and/or UTS 165, you can file a complaint with the Office of Employee Benefits and it will be fully investigated. Information about how to file a HIPAA complaint is included in the UT System Notice of Privacy Practices and the UT System Administrations Privacy Policies in the HIPAA section of this website.
Will any other premium program be implemented under the UT SELECT or UT CARE Medical Plans?
There are no plans to implement any additional premium programs at this time.
