A. Tobacco use is smoking tobacco in such forms as a cigarette, pipe or cigar, or using smokeless tobacco, such as snuff or chewing tobacco, within the past six months. Q. What if I did not complete my certification by the November 15 deadline? A. Your monthly premium for January 2010 will include the $25 surcharge. After your certification is signed, your premium will be adjusted and the surcharge will be removed the following month. Your premium cannot be adjusted retroactively, and any amount you will have paid in surcharges will not be refunded. To certfiy, complete a Certification Regarding Tobacco Use form and return it to your benefits administrator.