As the effective date of Pennsylvania’s Clean Indoor Air Act approaches, businesses may wish to seize the opportunity to create a comprehensive tobacco-free workplace program including wellness initiatives. The no smoking law applies to all indoor work areas and permits an employer to completely prohibit smoking on its property. However, legal and employee relations considerations suggest an integrated approach to workplace smoking.
Smoking-related business cost are well documented. The Center for Disease Control has the following statistics on smoking:
- For 1997–2001, cigarette smoking was estimated to be responsible for $167 billion in annual health-related economic losses in the United States ($75 billion in direct medical costs, and $92 billion in lost productivity), or about $3,561 per adult smoker.
- An estimated, 20.8% of all adults (45.3 million people) smoke cigarettes in the United States.
- Among current U.S. adult smokers, 70% report that they want to quit completely. In 2006, an estimated 19.2 million (44.2%) adult smokers had stopped smoking for at least 1 day during the preceding 12 months because they were trying to quit.
Design of an effective wellness program to address smoking can take many forms and requires collaboration between insurance brokers, benefit providers and legal advisors in light of limitations placed on certain aspects of their design including HIPAA’s Nondiscrimination Requirements. HIPAA regulations affect the design of wellness programs that take into account "health factors" when providing incentives under the program. Programs such as the following that do not take into account a participant’s health factors when a reward is given or withheld for participation by an employee or beneficiary:
- Health Assessments
- Diagnostic testing that does not take into account test results
- Preventive care encouragement incentives such as waivers of co-pays or deductibles
- Smoking cessation programs so long as the benefit is received regardless of whether the employee quits smoking
- Health education seminars
- Gym membership reimbursement
Wellness programs that give rewards for healthy conduct or that penalize unhealthy activities (like smoking) must meet all of the five following standards:
- Limited Reward: All rewards offered under the program must not exceed 20% of the cost of coverage (total amount of employee and employer contribution). The reward can be in the form of a discount or rebate of premium or contribution; waiver of deductible, copayment or coinsurance; or the value of a benefit provided under the plan.
- Reasonably Designed to Promote Health or Prevent Disease: The plan must have a reasonable chance of improving health or preventing disease in a way that is not overly burdensome.
- No More that Annual Qualification for Award: Individuals eligible to participate must be given the opportunity to qualify at least once a year.
- Uniform Reward Availability for "Similarly Situated" Individuals: The reward must be available to all similarly situated individuals and there must be a reasonable alternative for receiving the reward for any individual for whom it is unreasonably difficult due to a medical condition or for whom it is medically inadvisable to attempt to obtain the applicable standard. Physician verification may be required.
- Plan Material must Describe all Terms: The plan must describe all terms of the program and the availability of a reasonable alternative. The following language may be used to satisfy the alternative:
"If it is unreasonably difficult due to a medical condition for you to achieve the standards for the reward under this program, or if it is medically inadvisable for you to attempt to achieve the standards for the reward under this program, call us at and we will work with you to develop another way to qualify for the reward."
Business initiatives to regulate off duty conduct have some legal risk. However, courts have so far rejected smoker’s claims of disability based upon nicotine addiction.