PROVIDENCE – Eager to quit smoking, or to get your employees to do so? A new state insurance regulation may make it easier, or at least more affordable.
Effective on Aug. 14, the regulation requires health plans to cover an array of tobacco cessation treatments, including counseling and, if they cover prescriptions, nicotine replacement therapy and the latest treatments identified as effective by the U.S. Department of Health and Human Services.
That means the patch, nicotine gum, Zyban and Chantix should be covered under most plans, as well as one-on-one counseling, phone counseling or group therapy for at least eight half-hour sessions or its equivalent.
The regulation, issued by Health Insurance Commissioner Christopher F. Koller’s office, applies to all individual and group health plans that cover doctor’s office visits, major medical or similar “comprehensive-type” coverage. Still, there are exceptions.
For starters, employers who are self-insured (a common practice among large companies) are exempt under federal law. In addition, limited-benefit policies covering only long-term care, disability, Medicare supplemental insurance, etc. are exempt.
Copayments and/or deductibles may be imposed, and health plans may still review the medical necessity of treating each patient or apply their normal managed-care practices.
Still, the change is expected to improve access to tobacco cessation treatment across the state, and Dr. David R. Gifford, director of the R.I. Department of Health, applauded that.
“Each year, tobacco use claims the lives of more than 1,600 adult smokers in our state and adds $506 million to health care-related costs,” he said in a news release. “Each person that is trying to quit is unique. By offering more variety in treatment strategies that are covered by health insurance, we are giving more options to help them succeed and be tobacco free.”
Under the regulation, health plans must report each year by March 15 how they are complying with the requirement, and consumers will be able to easily determine what their plan covers.
The R.I. Tobacco Control Program provides a “quit line” service for Rhode Islanders (1-800-TRY-TO-STOP) and partners with the Rhode Island Health Centers Association to provide tobacco cessation services for the uninsured tobacco users in the state.
To read the regulation, go to the OHIC Web site. To learn more about tobacco cessation programs in the state, go the Department of Health Web site.
