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Microsoft word - vincennes university 2013 tobacco surcharge.docVincennes University Tobacco User Surcharge
Vincennes University's greatest asset is the well-being of its employees. The institution's
wellness initiatives are designed to prevent illness, improve quality of life and decrease health
care costs. Effective January 1, 2013, tobacco users on the Vincennes University health care
plan will pay a $25 biweekly surcharge. It is important that employees understand that the State
of Indiana’s surcharge for tobacco-users is $35. VU will be moving in this direction in 2014 in
order to align with statewide initiatives.
All employees covered under a Vincennes University health care plan must certify annually
whether you and/or your spouse (if covered under VU’s plan) use tobacco products or are
tobacco-free by completing the online Tobacco Affidavit under the Employee tab of the MyVU
web portal. The deadline to complete this Affidavit is Monday, December 17, 2012 for the
2013 plan year. Please refer to the Instructions for Electronic Signature of Tobacco Affidavit for
detailed instructions for completing this online form. If the online certification is not
completed, the surcharge will be automatically applied effective January 1, 2013 and will
remain in place for the 2013 plan year.
Tobacco includes any form of tobacco products that are smoked (e.g. cigarettes, cigars, pipes),
applied to the gums (dipping and chewing tobacco), and/or inhaled as snuff.
To certify as a non-tobacco user, you and your spouse (if covered under VU’s plan) must be tobacco-free. Complete the Affidavit by December 17, 2012 and the $25 biweekly surcharge will be waived for the 2013 plan year. Intentional falsification of this affidavit could lead to the loss of health care coverage.
If you and/or your spouse are a tobacco user (if covered under VU’s plan), certify the Affidavit by December 17, 2012 as such and VU will provide opportunities for you to waive the surcharge. Those who are not tobacco-free can participate in a tobacco cessation program. Tobacco cessation workshops that are endorsed by the American Lung Association will be made available to employees and spouses on the Vincennes campus. Alternative programs will be available for employees at other locations. Please contact Rhonda Laue in Human Resources at firstname.lastname@example.org for more information. The initial tobacco cessation class will be provided free of charge to employees and spouses. In addition, the VU employee medical plan will cover 100% of the cost of tobacco cessation prescription drugs. Coverage is limited to a 180-day supply per covered individual per year. Covered prescription drugs include Chantix, Zyban (bupropion), and Nicotrol. Upon successful completion of the program (the employee and spouse become tobacco-free) the surcharge will be waived.
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