CO-PAY ON TOBACCO CESSATION MEDICATIONS
CARE THAT FOCUSES ON YOU
T O B A C C O U S E R S U R C H A R G E
$ 25
$ 650
PER PAYCHECK
PER YEAR
Upon hire , and annually thereafter , employees enrolled in a City of Arlington medical plan must self-report as a tobacco user if they have used tobacco an average of four or more times per week within the past six months . This includes , but is not limited to , cigars , cigarettes , chewing or pipe tobacco , snuff , other smokeless tobacco products , e-cigarettes , vaporizers and other tobacco products including all Electronic Nicotine Delivery Systems ( ENDS ). Religious and ceremonial uses of tobacco are excluded from this provision .
If an employee does not 1 ) complete the Tobacco Use Affidavit form ( new hires ) or 2 ) complete the self-reporting information during online annual enrollment , they will be defaulted into the tobacco user status , subject to the Tobacco User Surcharge rate . This is a self-reported status , so employees should take action to indicate their tobacco user status .
Any information that is false and / or inaccurate or failing to self-report tobacco use is a material misrepresentation . This conduct may result in disciplinary action up to and including termination of employment , personal liability for benefits received and / or criminal prosecution .
T H E T I M E TO Q U I T IS N O W
Whether you ’ re doing it for yourself or someone else , the City of Arlington is here to support you in your decision to stop smoking .
$ 0 $ 0
CO-PAY ON TOBACCO CESSATION MEDICATIONS
Employees on the City ’ s medical plans have access to $ 0 copay tobacco cessation medications . Visit the Human Resources portal for a complete list and for additional resources to help you quit smoking , once and for all .
TOBACCO CESSATION PROGRAMS
Upon completion of a Tobacco Cessation Program , available at no-cost through many public health entities , submit a new Tobacco Use Affidavit along with the program completion documentation to Human Resources to stop the $ 25 surcharge for the balance of the plan year .
City of Arlington / EMPLOYEE BENEFITS GUIDE 2021
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