Page 11 - Enrollment Guide
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Tobacco Surcharge




A $100 monthly surcharge will be applied if you and/or your covered
spouse are tobacco users and choose to enroll into the 2016 medical plan.

This program is being implemented to discourage the use of tobacco
products because smoking and other forms of tobacco use are harmful
to health and contribute to the rising costs of health care. You and/or
your spouse will have the opportunity to complete a tobacco cessation
program to avoid this surcharge in 2016. You and/or your spouse must
complete the tobacco cessation course by March 31, 2016. You will certify
as you are doing your enrollment in PlanSource your and/or your spouse’s

current tobacco/non-tobacco status and intention of participating in
the tobacco cessation program. If you and/or your spouse have not
completed the program by March 31, you will start to see the surcharge
on your check.


Tobacco products include, but are not limited to, cigarettes, cigars, pipe
tobacco, chewing or dipping tobacco, snuff, tobacco packets, hookah, and
electronic cigarettes (e-cigs or vaping).









































Benefit Guide 2016
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