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State of Indiana Participating School Corporations Tobacco Use Agreement and Request for Premium Reduction For Plan Year 2023 In exchange for a $75.83 monthly reduction in my state employee group
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How to fill out non-tobacco use incentive
How to fill out non-tobacco use incentive
01
Obtain the non-tobacco use incentive form from your insurance provider or employer.
02
Fill out the form completely and accurately, providing all necessary information about your non-tobacco use status.
03
Attach any supporting documentation, such as a signed affidavit or proof of tobacco cessation program completion, if required.
04
Submit the completed form to your insurance provider or employer by the specified deadline.
Who needs non-tobacco use incentive?
01
Individuals who do not use tobacco products and want to qualify for potential cost savings or incentives from their insurance provider or employer.
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What is non-tobacco use incentive?
Non-tobacco use incentive is a discount or reward offered by insurance companies to individuals who do not use tobacco products.
Who is required to file non-tobacco use incentive?
Insurance policyholders who wish to qualify for the discount or reward must file non-tobacco use incentive forms with their insurance provider.
How to fill out non-tobacco use incentive?
To fill out non-tobacco use incentive forms, policyholders must provide accurate information about their tobacco use status and follow any instructions provided by their insurance provider.
What is the purpose of non-tobacco use incentive?
The purpose of non-tobacco use incentive is to encourage individuals to maintain a healthy lifestyle by not using tobacco products.
What information must be reported on non-tobacco use incentive?
Policyholders must report their tobacco use status and any changes to their tobacco use habits on non-tobacco use incentive forms.
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