Tobacco use surcharge

How do I attest (respond)?

Complete and submit the appropriate enrollment form as directed on the form. Use the Premium Surcharge Help Sheet to fill out the premium surcharge sections of the form.

University of Washington employees must attest through Workday.

Who needs to attest (respond)?

You need to respond to this surcharge if you are one of the following PEBB medical plan subscribers:

• Employee
• Retiree not enrolled in Medicare Part A and Part B
• COBRA not enrolled in Medicare Part A and Part B
• PEBB Continuation Coverage (unpaid leave)

You do not need to respond if you are not one of these subscribers. The premium surcharge will not apply to your account.

What happens if I do not respond?

You will be charged the monthly $25 surcharge in addition to your medical plan premium.

How do I report a change?

Use one of the following options to report a change to your previous attestation:

• Use My Account
  OR
• Complete and submit the Premium Surcharge Change Form. You can use the Premium Surcharge Help Sheet to help fill out the form.

Note: University of Washington employees must report a change through Workday.

When can I report a change?

You can report a change any time you or any enrolled dependents you reported as using tobacco products do any of the following:

• Stop using tobacco products for at least two months.
• Enroll in your PEBB medical plan’s tobacco cessation program (for ages 18 and older).
• Access the information and resources in Smokefree Teen (for ages 13-17).

You must also report a change if you or any enrolled dependent age 13 or older starts using a tobacco product, or stops participating in your PEBB medical plan’s tobacco cessation program.

When will my change take effect?

Changes that result in a premium surcharge will begin the first day of the month following the status change (the date the family member(s) started using tobacco products). If that day is the first of the month, the change to the surcharge begins on that day. Changes that result in removing a premium surcharge will begin the first day of the month following receipt of the attestation. If that day is the first of the month, the change to the surcharge begins on that day.

About the tobacco use premium surcharge

A monthly $25 tobacco use premium surcharge is required in addition to your medical plan premium if you or a dependent (age 13 and older) enrolled on your PEBB medical uses a tobacco product.

You do not have to pay this surcharge if you attest (respond) that:

• You and all enrolled dependents ages 13 and older do not use tobacco products.
• All tobacco users ages 18 and older are enrolled in your PEBB medical plan’s tobacco cessation program. Tobacco users ages 13-17 are considered enrolled in a tobacco cessation program if they access information and resources in Smokefree Teen.

Enrolled dependents ages 12 and younger are automatically defaulted as non-tobacco-users.

Note: As long as any dependent covered under your PEBB medical plan uses a tobacco product, you will be charged the tobacco use premium surcharge.

What is tobacco use?

"Tobacco use" means any use of tobacco products within the past two months. Tobacco use, however, does not include the religious or ceremonial use of tobacco.

What are tobacco products?

Tobacco products" means any product made with or derived from tobacco that is intended for human consumption, including any component, part, or accessory of a tobacco product. This includes, but is not limited to, cigars, cigarettes, pipe tobacco, chewing tobacco, snuff, and other tobacco products. It does not include e-cigarettes or United States Food and Drug Administration (FDA) approved quit aids.

For more details, see the Premium Surcharge Help Sheet.