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Human Resources

Open Enrollment

Tobacco-free Affidavit

Available November 6 - 17, 2017

The IU Tobacco-free Affidavit applies to employees and their spouses enrolled in an IU medical plan.

During Open Enrollment you can complete an affidavit indicating you and/or spouse do not use tobacco and will not in the future. Completing the affidavit will reduce your premium contribution by $25 per month for you or your spouse, or $50 for both.

For purposes of the affidavit, tobacco includes any form of tobacco or nicotine products that are smoked, applied to the gums, and/or inhaled (e.g., e-cigarettes, nicotine delivery systems). If a person declaring non-use of tobacco begins using tobacco during the year, she/he is no longer eligible for the premium reduction and must report this change to IU Human Resources immediately.

As an alternative to completing the affidavit, you and/or your spouse may still receive the premium reduction by completing the Quit For Life® tobacco cessation program. Program completion is defined as completing at least five calls with a Quit Coach. Participants will receive the premium reduction upon certification that the required coaching calls have been completed. Find more information about the program at the smoking cessation web page.

Quit For Life® Tobacco Cessation Program

Medical benefits cover the cost of the Optum Quit For Life® tobacco cessation program. The benefit is available to all full-time Academic and Staff employees and spouses covered by an IU-sponsored medical plan, and is fully paid by the University. The program includes an individualized telephone-based cessation program for each participant; a “Quit Coach” assigned to each participant; nicotine replacement therapy, as needed; and one year of follow-up phone and web assistance to help participants stay tobacco free.

To enroll, individuals should call 866-784-8454 or visit





Page updated: October 2017

IU Human Resources
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