• ActionToQuit NY State Smokers Quitline

Wise Shopper: Questions to Ask Health Plans

When reviewing current health plans or bidding for a new one, benefits managers can incorporate some or all of the following "wise shopper" questions into written specifications:

be a wise shopper

How does the health plan identify and document smokers and smoking cessation interventions?

  1. List covered smoking cessation drugs. How frequently are these offered, and for what period annually?
  2. What type of counseling (e.g., in person, online, telephone) is covered, how often is counseling covered annually, and for what period (e.g., 90 days twice per year)?
  3. What counseling/educational programs exist (group, telephonic, Internet based)? Do these include the entire geographic area for our employee population? Please provide a calendar of programs currently offered and their location(s). What are the programs’ quit rates and how are they calculated?
  4. Describe the plan design for smoking cessation (e.g., co-pay, etc.). Is co-pay in line with other medications?
  5. Are over-the-counter medications, such as nicotine patches and gum, covered? Is there a co-pay?
  6. Who is eligible for smoking cessation benefits/drugs/counseling? Does this include all covered individuals or only those with a drug benefit?
  7. What other educational or counseling materials are provided (e.g., hard copy, on-line, other)?
  8. Will a photocopy from the standard contract describing covered smoking cessations benefits be provided to share with employees?
  9. How does the plan motivate healthcare providers to provide smoking cessation counseling (e.g., withholds, bonuses)?
  10. How is the percentage of smokers who have received treatment assessed? How is the success of the smoking cessation initiatives evaluated?

Smoking cessation programs cost little and provide a measurable significant benefit, even when the benefit is measured only in terms of short term direct health care cost savings. The cost of these programs is small when put into the context of employers’ health benefits programs. For benefits decision making, the small cost, along with the medical effectiveness, could easily justify covering smoking cessation programs.