Paul G

I was talking to a friend that works at Bi-Lo this weekend. She is a manager there. They have just implemented high health insurance premiums for smokers.

That has been talked about and some companies started doing that already. See these articles:

Smokers paying extra for health insurance - Addictions - MSNBC.com

The State | 08/14/2008 | Health care premiums rising for SC public workers who smoke

USATODAY.com - Employers charging smokers extra for health insurance

But there were a few things she said that really caught my attention.

--If you mark your insurance as a non-smoker and then file a claim for smoking related problems, or worse die from smoking, then you are responsible for ALL medical charges

--Their definition of smoking was using smoke tobacco products once in the last 12 month. So if I as a non smoker smoke a cigar one night with the boys, I'm a smoker. Or someone that is a non smoker participates in a pipe ceremony you are considered a smoker.

Has anyone else see this at your job yet?

I understand the concern for employers. But that definition is a bit broad. And what about other habits of people that cause health problems--being overweight, eating disorders, etc. If I have a Big Mac once in 12 months am I going to be charged an extra premium for my health insurance?

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SheTurtle

I worked in the insurance industry for years, and insurers and employers alike were looking for ways to reward nonsmokers and penalize smokers. In the health insurance field, I primarily did due diligence work for individuals and small businesses.

Like it or not, habitual smokers have more than the average amount of health problems, and a higher rate of deaths due to conditions such as heart problems, emphysema, and lung cancer. They require more medications, doctor's appointments, surgeries, and equipment than nonsmokers. A company's health insurance pays claims on conditions that occur because of what people do on and off the job, so saying that smokers are being discriminated against because of habits they have off the job and outside of the workplace simply don't fly. Your kid didn't get measles on the job, but the claims were paid anyway.

Up to this point, if a group had an HMO plan, health questionnaires were done by the HR office and sent in with the enrollment forms, which usually had a very brief health questionnaire. PPOs required detailed health questionnaires from all of the employees and from the group administrator.

When rates are quoted for new plans or renewals, health histories were taken into consideration along with factors such as the average age of the group. The younger and healthier the group members are, the lower the premiums. A group with older members with various health issues would be quoted higher premiums. The risk, or factors such as age and health issues, would be spread out and averaged out for the entire group. Depending on the state and the plan, sometimes rates were age-banded in the group. The older an employee was, the higher that person's premium. An individual employee's habits, such as smoking, alcohol use, and drug use, were rarely taken into consideration for each individual employee.

What will happen now is that each employee who is considered to be a smoker will have an uptick in their premium rates. The criteria for smoker and nonsmoker are similar to that for life insurance, but for life insurance purposes, a person is considered to be a smoker if nicotine shows up in a blood/urine test. It doesn't look like blood/urine tests will be required at this point, but don't be surprised if that happens. As far as determining whether or not a condition is smoking related, that might be tricky, especially for the person who smokes very occasionally or for ceremonial purposes. It will have to take a doctor's opinion to determine whether that kind of person has a smoking-related disorder, and that smoking was the primary cause of that condition. Smokers and nonsmokers alike have cardiac conditions, lung cancer, and emphysema. Woe to the nonsmoker who may be denied benefits because a nurse practitioner in the insurance company's head office just might think that nonsmoker's problems may be smoking related, especially if that person is exposed to second-hand smoke.