Insights

January 12, 2016


On Dec. 11, 2015, the Utah Department of Insurance (DOI) published Bulletin 2015-11. The bulletin applies to health insurance companies and relates to preventive coverage requirements for tobacco cessation services. As background, PPACA requires non-grandfathered health benefit plans to provide coverage for certain preventive services without imposing cost sharing. Preventive services include tobacco use screening and tobacco cessation interventions. The bulletin states that the Utah DOI will consider a plan to be in compliance if it meets the federal recommended standards for coverage of those screenings and interventions. Under the federal standards, the insurer would be considered to be in compliance if the health benefit plan covers, without cost sharing or prior authorization, screening for tobacco use and, for those who use tobacco products, at least two quit attempts per year, so long as the attempt includes four tobacco-cessation counseling sessions (individual, group or telephone) of at least 10 minutes each and all FDA-approved tobacco-cessation medications (both prescription and over-the-counter, for a 90-day treatment regimen when prescribed by a health care provider). Under Utah law, preventive benefits for tobacco screening and cessation would apply to all lighted or heated tobacco product in any form, including cigar, cigarette, pipe or hookah (including any electronic format).

While the bulletin contains no new employer requirements, employers should be aware of the insurer requirement should any questions arise relating to coverage of tobacco screening and cessation.

Bulletin 2015-11 »