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Premium Discounts

The following frequently asked questions about premium discounts are not meant to be exhaustive. Refer to your health benefits plan book or contact the SEIB for more information.

Non-Tobacco User Premium Discount

What is the Non-Tobacco User Premium Discount?

The non-tobacco user premium discount is a deduction from your monthly health insurance premium available to subscribers and covered spouses who have not used tobacco products in the last 12 consecutive months.

Who is eligible for the Non-Tobacco User Premium Discount?
The following individuals who are non-tobacco users are eligible for the premium discount:
  • All active employees;
  • spouses of active employees;
  • Medicare retirees;
  • spouses of Medicare retirees;
  • non-Medicare retirees; and
  • non-Medicare spouses of retirees.
Is a Non-Tobacco User Premium Discount available to both the subscriber and the covered spouse separately?

Yes. A separate non-tobacco user premium discount is available to both the subscriber and the covered spouse. If you and your covered spouse both use tobacco products, you and your covered spouse will each be subject to a separate tobacco user premium of $60.

Here’s how the premium structure will be applied:

  • If only you or your covered spouse uses tobacco products, your monthly tobacco user premium will be $60.
  • If both you and your covered spouse use tobacco products, your monthly tobacco user premium will be $120 ($60 for you and $60 for your covered spouse).
How do I apply for the Non-Tobacco User Premium Discount?

To obtain the discount, you and/or your covered spouse must complete and submit a non-tobacco user premium discount application to the SEIB verifying that the applicant has not used tobacco products in the last 12 consecutive months. Applications are available from the SEIB or the website. No refunds are allowed for failure to submit an application.

Is it possible to obtain the Non-Tobacco User Premium Discount even if I have used tobacco products in the last 12 months?
If you and/or your spouse have used tobacco products within the last 12 months, eligibility for the discount may be obtained by completing an SEIB approved tobacco cessation program. Upon completion of an approved Tobacco Cessation Program, you must submit a completed annual tobacco user premium discount application (IB06), along with required documentation, to the SEIB each year.
When should I apply for the Non-Tobacco User Premium Discount?

Employees have 60 days from their enrollment date to apply for the non-tobacco user premium discount. Covered spouses of active employees, non-Medicare retirees and non-Medicare covered spouses of retirees have 60 days from their initial effective date of coverage to apply for the non-tobacco user discount.

For those who were not eligible for the premium discount at the date of hire, you or your spouse may apply for the discount when the applicant has not used tobacco products in the last 12 consecutive months.

What should I do if my covered spouse or I start using tobacco products while the premium discount is in place?

It is your responsibility to notify the SEIB immediately if you or your covered spouse starts using tobacco products while the premium discount is in place. If you fail to notify the SEIB, you could be subject to disciplinary action, up to and including termination of coverage, and will be required to repay all discounts.

Wellness Premium Discount

What is the Wellness Premium Discount?

The wellness premium discount is a deduction from your monthly health insurance premium available to those individuals who complete the wellness requirements established under the SEIB’s Wellness Program.

What is the SEIB Wellness Program?

The SEIB Wellness Program is voluntary and you are not required to participate in the wellness program or any components of the biometric screening. If you choose to participate, you will be asked to complete a biometric screening, which includes measuring your height, weight, and waist size, taking your blood pressure and a blood sample. The blood sample checks your cholesterol (total, HDL (good), LDL (bad), and triglycerides) and glucose. You will be asked if you have or have had high cholesterol, high blood pressure, or diabetes and if you take medicine for those conditions. The screening intends to let you know if you are at risk for certain medical conditions resulting from obesity, high blood pressure, high cholesterol, or diabetes.

Who is eligible for the Wellness Premium Discount?
The following individuals covered by the SEHIP (Group 13000) and who participated in the SEIB wellness program are eligible for the wellness premium discount:
  • All active employees;
  • spouses of active employees;
  • non-Medicare retirees; and
  • non-Medicare spouses of retirees.
Is a Wellness Premium Discount available to both the eligible subscriber and the eligible covered spouse separately?

Yes. A separate wellness premium discount is available to both the eligible subscriber and the eligible covered spouse. If you and your covered spouse both fail to meet the SEIB’s Wellness Program requirements, you and your covered spouse will each be subject to a separate premium of $25.

Here’s how the premium structure will be applied:

  • for those with single coverage or family coverage without a spouse:
    • your monthly wellness premium will be $0 if you complete your wellness program requirements.
    • your monthly wellness premium will be $25 if you do not complete your wellness program requirements.
  • for those with family coverage and the spouse is covered:
    • If you and your covered spouse both complete the wellness program requirements, your wellness premium will be $0.
    • If you or your covered spouse complete the wellness program requirements, but not both, your monthly wellness premium will be $25.
    • If neither you nor your covered spouse complete the wellness program requirements, your monthly wellness premium will be $50.
What risk factors are screened for during the wellness screening?
Each plan year every eligible individual must be screened for the following health risk factors:
  • blood pressure;
  • cholesterol;
  • glucose; and
  • body mass index.
Where do I go to get a wellness screening?
You can be screened for these risk factors in one of several ways:
  • through the SEIB’s Worksite Wellness Screening Program;
  • through a local Health Department;
  • through a SEIB certified Pharmacy location; or
  • through your healthcare provider.
How am I determined to be at risk for one of the health risk factors?
You will be deemed at risk for one or more of these health risk factors if your:
  • Blood pressure systolic reading is 160 or above or your diastolic reading is 100 or above;
  • Cholesterol reading is 250 or above;
  • Glucose reading is 200 or above; or
  • Body mass index is 40 or above.

Eligible individuals who are deemed by the SEIB to be at risk for any of the above health risk factors are eligible for an office visit referral with no office visit copay.

If I am deemed at risk for one or more of the health risk factors, can I still receive the premium discount?
Yes. If your screening values show that you are at risk, you will be asked to complete one of the following to receive the premium discount:
  • Submit a provider screening form completed by your health care provider, i.e., your doctor, physician assistant, or nurse practitioner. This form indicates that you consulted with your provider about the identified risk. The form does not have to indicate any improvement in the identified risk for you to receive the premium discount. It is a good idea to have your provider complete and sign your form while you are in for an office visit;
  • Submit a completed and signed office referral form indicating that you have been counseled by a healthcare provider for your identified risk(s);
  • Submit proof of participation in a SEIB approved exercise or weight management program. You must provide the SEIB with the name of the program, dates, and location of participation, and a phone number for verification of your participation; or
  • Provide valid proof that you are self-managing and have made an improvement in your identified risk(s). You must provide documentation of your improvement.
When will my Wellness Premium Discount be effective?

The effective date of the wellness premium discount depends on when the screening results and/or other documentation is submitted to the SEIB. However, for the wellness premium discount to be effective on January 1 of a succeeding year, you must qualify no later than October 31 of the preceding year.

New employees will have 90 days from their date of hire to apply for the wellness premium discount. Covered spouses of active employees, non-Medicare retirees and non-Medicare covered spouses of retirees have 90 days from their effective date of coverage to apply for the wellness premium discount.

Federal Poverty Level Premium Discount

What is the Federal Poverty Level Premium Discount?

The Federal Poverty Level (FPL) Premium Discount is a percentage discount off your monthly health insurance premium based on your adjusted gross income and household size.

Who is eligible for Federal Poverty Level Premium Discount?

Active and retired employees whose adjusted gross income is less than or equal to 300% of the FPL, as defined by federal law, may be eligible for a percentage discount off the approved premium.

How do I obtain the Federal Poverty Level Premium Discount?

To obtain the discount, you and your spouse must submit a completed FPL Premium Discount Application to the SEIB and furnish acceptable proof of total adjusted gross income by providing your current (i.e. immediately preceding year) federal income tax return transcript. The discount will be effective on the first day of the second month after SEIB’s receipt and approval of the application and transcript. The discount will expire on June 30th. You must reapply every year. No refunds will be allowed for late or incomplete applications. No refunds will be allowed for failure to submit an application.

The discount does not apply to members on Leave of Absence, COBRA, or surviving dependent coverage.

How is my income level determined?

You must provide a copy of your current (i.e. immediately preceding year) federal income tax return transcript when you send the application to the SEIB. If you are married and file taxes separately, you must also include a copy of your spouses’ current (i.e. immediately preceding year) federal income tax return transcript. Include all pages of the transcript(s). There is no charge to get your transcript from the Internal Revenue Service (IRS). To receive your free federal income tax return transcript, visit IRS Get Transcript or call 800-908-9946. You should receive your transcript within 7-10 business days.

How is my household size determined?

The SEIB will use the number of dependents shown on your federal income tax return transcript to determine your household size for purposes of calculating your potential premium discount.

How much is the premium discount if I qualify for the Federal Poverty Level Discount?
The premium discount will be applied as follows:
  • Over 300% of the FPL – employee pays 100% of the employee premium
  • 251%-300% of the FPL – employee premium reduced 10%
  • 201%-250% of the FPL – employee premium reduced 20%
  • 151%-200% of the FPL – employee premium reduced 30%
  • 101%-150% of the FPL – employee premium reduced 40%
  • 100% or less of the FPL – employee premium reduced 50%

Preventive Screening Program

What is the Preventive Screening Program and to whom does it apply?

SEIB is offering, through BCBS, a preventive screening premium discount program that encourages healthy habits to support and improve your overall health. You might ask, “What is a preventive screening?” National guidelines for managing certain disease processes are recommended to better manage your health. If you are identified, it simply means that you are missing one or more of the recommended guidelines, such as a lab test, examination, or prescription medication, necessary to manage your health. The program focuses on the following five healthcare standards:

  • Diabetes- Hemoglobin A1C test at least once a year;
  • Diabetes- eye exam at least once a year;
  • Cervical Cancer Screening- Pap test only;
  • Breast Cancer Screening;
  • Colon Cancer Screening.

This program applies to all active employees, covered spouses of active employees, non-Medicare retirees, and non-Medicare spouses of retirees enrolled in the SEHIP (Group 13000)

What happens if you need a Preventive Screening?

If previous claims reveal that you have not met the required guidelines for any of the healthcare standards listed above, you will receive a letter from BCBS outlining the necessary steps required. Members will have until October 31st to receive the required preventive screenings. If you do not meet the requirements, your monthly premium will increase by $25 per month beginning January 1st of the following year. However, you are not required to pay the $25 per month premium for the entire year if you receive the preventive screening anytime during the year.