Non‐Smoker Discount Affidavit

Effective June 1, 2015, to continue receiving health insurance coverage at a discounted rate, UCH and Hotwire employees must certify that either: (1) they do not smoke or use tobacco products, or (2) they have completed a smoking cessation program. Cigna offers a smoking cessation program at no cost to its members. By completing this program or another approved smoking cessation program, you will qualify for the discount.

Employees who cannot truthfully make this certification as of June 1, 2015 will be required to pay an additional five percent (5%) of the single employee health insurance premium. This translates to an additional $11.50 per pay period, or approximately $25.00 per month.

In order to certify your eligibility for the non-smoker discount, please complete the form below. 

Employees that do not currently qualify for the non-smoker discount have until June 1, 2015 to complete the smoking cessation program and submit this affidavit.  

Please contact Human Resources with any questions or concerns you have regarding this affidavit.

Please select one of the following options to qualify for the non-smoker’s discount.