Page 30 | Ball State University | Plan Year 2026 This compliance overview is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. Notice Regarding Tobacco Cessation TOBACCO CESSATION PROGRAMS: WELLNESS PROGRAM RULES & REGULATIONS GUIDELINES The ACA requires: 1. Insurers in the small group market to remove the tobacco surcharge for a tobacco user who agrees to enroll in a program that will help them quit. 2. Employers find and offer a tobacco cessation program for employees to participate in and pay for it. To satisfy the reasonable alternative standard, facts and circumstances such as the following will be considered: If the reasonable alternative standard is completion of an educational cessation program, the plan must make the educational program available instead of requiring an individual to find the program unassisted; the plan may not require the individual to pay for the cost of the program. There are 2 Types of Tobacco Cessation Wellness Programs: “Participatory Wellness Program” - HIPPA Nondiscrimination and The Affordable Care Act exception in connection with a group health plan is a “Participatory Wellness Program” where none of the conditions for obtaining the reward are based on an individual satisfying a standard related to a health factor, such as voluntarily completion of a tobacco cessation program. Completion of a tobacco cessation program complies with the nondiscrimination requirements as long as the program is made available to all similarly situated individuals and does not require the individual to quit smoking at the end of the program. (not subject to the 5 requirements that apply to health-contingent wellness programs) “Outcomes Based Program” - If a plan is offering a reward based on an individual’s ability to stop smoking, it is considered an “Outcomes Based Program” and subject to the Five Factor Requirements for a HIPPA & ACA approved outcomes-based tobacco cessation program: 1. The program is reasonably designed to promote health and prevent disease 2. The premium differential is not more than 50% of the total cost of the employee-only coverage (or 50% of the cost of coverage if dependents can participate in the program) 3. Individuals eligible for the program are given an opportunity to quality for the discount at least once every year 4. The program provides a reasonable alternative standard (RAS) without physician verification that the individual met the standard, to all individuals who do not meet the otherwise applicable standard (those who use tobacco products). 5. All plan materials (SPD, Open Enrollment, Benefits Website) describing the terms of the premium differential (and any disclosure that an individual did not satisfy the wellness program standard) describe the availability of a reasonable alternative standard to qualify for the lower premium The American Lung Association suggests that a Comprehensive Tobacco Cessation Benefit Includes: Easy access to seven medications and three types of counseling recommended by the U.S. Department of Health and Human Services (HHS) to treat tobacco use and nicotine dependence including: Individual Counseling, Nicotine Patch, Nicotine Nasal Spray, Group Counseling, Nicotine Gum, Nicotine Inhaler, Phone Counseling, Nicotine Lozenge, and Chantix.