Tobacco-Free Attestation

HealthChoice Tobacco-Free Attestation

Welcome to the online HealthChoice tobacco-free attestation. Completing this attestation will ensure that you and/or your covered dependents will be enrolled or remain enrolled in the HealthChoice High or Basic plan for the 2018 plan year.

Enter the primary member's information below and select the continue button to access the attestation page. Once you complete the attestation, you can print a copy for your records.

This application is to be completed only by the HealthChoice primary member. Dependents do not need to complete a separate attestation.

If you need to reprint your attestation, please re-enter your information below and select the continue button. You will be given a link in the notification box to print a copy for yourself.


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