Pillar #1: Tobacco Use

Key Messages

1a. Establish and enforce tobacco-free worksite policies.

This one is straightforward – your organization must have a comprehensive tobacco-free (not simply smoke-free) policy that is communicated and enforced.
It must be an employment policy, and therefore, apply to all US-based employees, in all sites and facilities, whether they are owned, leased or shared.
The policy must apply to your entire worksite -- both indoors and outdoors - and for leased/shared facilities, the use of tobacco should be prohibited near the entrances to your buildings. The distance (i.e. # of feet) will vary based upon your circumstances.
Providing designated areas for smoking or separately ventilated facilities does not meet this requirement.
Communications message should be an integrated, non-punitive message: "We care about your health" and "here are the programs and support we're offering to help you stop using tobacco."

1b. Ensure that health benefit plans include coverage at no cost for evidence-based tobacco treatments (counseling and medications).

• This one is straightforward – all health benefits plans must include 100% coverage for counseling and medications since they are considered to be evidence-based tobacco-cessation treatments.
• No deductibles, no co-pays, and no co-insurance may apply.
• “Health benefit plans” may include reimbursement accounts or any other third party vendor arrangement whereby employees receive 100% reimbursement for all evidence-based tobacco-cessation treatments (counseling and medications).
• It applies to all plans, whether self-insured or fully insured, including products such as HMOs.  The only exception is out-of-network benefits under a POS plan, provided 100% coverage is available in-network.
• Note that medications means Rx and OTC.
• For Rx medications, note that a) generic substitutes are acceptable and b) not all FDA-approved tobacco-cessation medicines must be covered at 100%; at least one Rx prescription medication must be covered in full.
• While the Gold Standard requires 100% coverage for Rx and OTC tobacco-cessation medications, it is reasonable for an employer to communicate a limitation on the coverage.  The limitation may be, for example, a specific number of quit attempts in a given time period or perhaps a dollar amount. This is an effective way of ensuring that individuals are serious about tobacco cessation when they seek assistance.  However, if an employee exceeds the limitation and has been unsuccessful in his or her attempts to quit, it is recommended that a Gold Standard organization would continue to pay for the medications at 100% provided the employee demonstrates a sincere interest and willingness to quit.  It is left to the employer’s discretion to identify the best way of assessing the employee’s commitment to quitting. The goal is to ensure that individuals receive the most effective assistance in quitting the use of tobacco while managing company dollars at the same time.