Tobacco-Free Attestation

HealthChoice Tobacco-Free Attestation


Welcome to the online 2019 Tobacco-free attestation. Completing this attestation will ensure that you and your covered dependents will be enrolled or remain enrolled in the HealthChoice High or Basic Plan for the 2019 plan year.

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

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

If at any time you need to locate your completed attestation, please re-enter your information below and select the continue button. You will be given a link to your attestation in the notification box.

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