Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: October 09, 2014

Program Area: Small Business Health Options Program (SHOP)

Question: If an employee attests to participating in a tobacco cessation program, what steps can Federally-facilitated Small Business Health Options Program (FF-SHOP) issuers take to ensure that the employee is actually participating in the tobacco cessation program?

Answer: An issuer may take any reasonable approach to confirm that an employee has satisfied the standard for obtaining a reward under a wellness program, such as a tobacco cessation program. If the employee is found to have not satisfied the wellness program standard, or the employee is found to have reported false or incorrect information about their tobacco use, the issuer may attempt to recoup from the employee the tobacco premium surcharge that should have been paid since the beginning of the plan year. The issuer may not, however, non-renew or discontinue or rescind the group health insurance coverage for this reason.

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