QuitLogix Meets Reasonable Alternative Guidelines

The Affordable Care Act (ACA) allows employers to provide a wellness incentive program that is based on specific employee health standards (known as "health-contingent wellness programs"). Incentives can be tied to participating in a wellness activity or achieving a health outcome for any of five health risk factors:

  • BMI
  • Blood pressure
  • Cholesterol
  • Glucose
  • Tobacco free

Under the ACA, employees can be charged a differential of up to 30% on their health insurance premiums if they don't meet their wellness plan's goal for BMI, blood pressure, cholesterol or glucose and up to a 50% differential if they are a tobacco user. However, to charge this differential employers or health plans must offer a "Reasonable Alternative" program to employees. 


Reasonable Alternative Tobacco Cessation Requirements

The ACA considers a program to be in compliance with tobacco use counseling and intervention coverage if the following are covered without cost sharing: 
  • At least two tobacco cessation attempts per year 
  • Four tobacco cessation counseling sessions of at least 10 minutes each (including telephone counseling, group counseling and individual counseling) without prior authorization
  • All Food and Drug Administration (FDA)-approved tobacco cessation medications (including both prescription and over-the-counter medications) are provided for a 90-day treatment regimen when prescribed by a health care provider without prior authorization

QuitLogix is a comprehensive tobacco cessation program that can be used to satisfy this requirement of the ACA, allowing employers to charge a premium differential.

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