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| Getting Prepared for Flu Season |
| 10/8/2009 |
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Health Insurance
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| The World Health Organization (WHO) is advising
countries in the northern hemisphere to prepare for a second wave of pandemic
spread. In many cities and towns, schools and hospitals are already dealing
with wide-spread outbreak. A vaccine for the H1N1 strain of flu is expected
later this fall, and the U.S. Centers for Disease Control suggest that the
following groups consider the vaccine: pregnant women, people who live with or
care for children younger than 6 months of age, healthcare and emergency
medical services personnel, persons between the ages of 6 months and 24 years
old, and people 25 through 64 years of age who are at higher risk for 2009 H1N1
because of chronic health disorders or compromised immune systems.
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| It’s always important to understand your health
insurance policy, but with the potential for an increased demand for health
care services, you need to be even more aware of your specific plan details.
Take a few minutes to read your policy carefully in order to answer the
following questions:
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1. Is the vaccination covered by my insurance?
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The seasonal flu vaccine and the H1N1 flu vaccine will be administered
separately. Because H1N1 vaccinations have not yet been authorized by the Food
and Drug Administration, they may not be covered by health insurance. Check
with your insurance company to verify that your coverage will extend to the
H1N1 vaccine.
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2. Do I have a cost-sharing responsibility for the
vaccinations?
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Many health insurance policies have co-payments for yearly flu vaccinations.
Ask your insurance company if you will have a co-pay for the H1N1 vaccine and
what the cost will be.
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3. If an office visit is required to obtain the
vaccinations, does it require a separate co-payment?
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4. Does your policy require a pre-authorization for hospital
admission or other services?
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5. What is your co-payment for the most common H1N1
treatments?
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The two drugs doctors can prescribe to treat H1N1 flu are Tamiflu and Relenza.
In addition, you should know of any limitations on the number of doses covered
by your policy – per prescription or per year.
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6. Does your policy cover over-the-counter medications?
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7. Is your coverage accepted at walk-in care facilities?
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If your area is heavily affected by the spread of the H1N1 flu outbreak, your
regular physician might not be able to see you in a timely manner.
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8. What is your out-of-network co-payment?
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If you must go to an out-of-network provider, be aware you will likely pay a
higher co-payment for your office visit and any tests run during the visit.
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Be prepared for any eventuality with the following checklist:
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Have your health insurance ID card readily available.
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Review your health insurance policy provisions. Know which doctors and
hospitals are in your network.
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Make note of your co-payments. Know how much a doctor’s office visit will cost.
Check to see if your co-payments go up if you go out-of-network.
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Keep handy a list of pharmacies and medications covered by your health
insurance policy.
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If you have plans to travel, make sure you check to see if there are any
doctors or medical facilities in-network where you will be visiting.
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Make sure you have contact details for your health insurance company available
in case you have questions.
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Ask your employer or insurance company for any and all applicable health
insurance information that might be available to you in a simple-to-reference
format. Post this information where it can easily be accessed by everyone.
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Business Interruption Insurance
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| Business owners might be concerned about having
to shut down their operations due to an outbreak or absenteeism. Check your
business interruption policy to see what eventualities will trigger coverage
under your plan. Coverage generally requires the interruption to be caused by
physical damage or loss (e.g., fire or weather). Business interruption policies
generally will not be triggered by epidemic or pandemic warnings or alerts from
public officials. Business owners will need to rely on existing risk management
and business continuity plans to mitigate losses due to emerging public health
crises.
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More Information
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The federal government has created a Web site with information:
www.pandemicflu.gov.
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The U.S. Centers for Disease Control also has extensive information about H1N1
Influenza on its Web site: www.cdc.gov/swineflu/.
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If you are unable to resolve any concerns you have about your health insurance
with your insurance company, contact the Alabama Department of Insurance at
800-433-3966. You may ask a question or file a complaint through its website at
www.aldoi.gov.
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| Beware of insurance fraud during this time of
heightened awareness. To avoid insurance fraud, make sure the company you're
dealing with is reputable and licensed to do business in your state. Before
signing any paperwork or writing a check, STOP; CALL the Alabama Department of
Insurance; and CONFIRM that the insurance company or agent is legitimate and
licensed in Alabama. |
