What You Should Know About Your Insurance Coverage and the H1N1 Influenza Outbreak – September is National Preparedness Month.

In light of the continuing spread of the H1N1 virus – or swine flu – the Delaware Department of Insurance (“DOI”) encourages consumers to include a flu response plan in their disaster preparations this year. The first step in making that plan is a comprehensive review of your insurance policies. Here are a few things you should look for:

Health Insurance

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.

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:

• Is the vaccination covered by my insurance?
• The seasonal flu vaccine and the H1N1 flu vaccine will be administered separately. The four major health insurance companies in Delaware have voluntarily agreed to cover the costs of the H1N1 vaccine until it is approved by the FDA. However, this is not the same as the cost of administering the vaccine. Check with your insurance company to see if the cost of administering the vaccine is covered by your policy.
• Do I have a cost-sharing responsibility for the vaccinations?
• 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.
• If an office visit is required to obtain the vaccinations, does it require a separate co-payment?
• Does your policy require a pre-authorization for hospital admission or other services?
• What is your co-payment for the most common H1N1 treatments?
• 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.
• Does your policy cover over-the-counter medications?
• Is your coverage accepted at walk-in care facilities?
• 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.
• What is your out-of-network co-payment?
• 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.

Be prepared for any eventuality with the following checklist:

• Have your health insurance ID card readily available.
• Review your health insurance policy provisions. Know which doctors and hospitals are in your network.
• 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.
• Keep handy a list of pharmacies and medications covered by your health insurance policy.
• 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.
• Make sure you have contact details for your health insurance company available in case you have questions.
• 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.

More Information:

The federal government has created a web site with information: www.flu.gov.

The U.S. Centers for Disease Control also has extensive information about H1N1 Influenza on its web site: www.cdc.gov/h1n1flu/.

If you are unable to resolve any concerns you have about your health insurance with your insurance company, call the DOI toll-free at (800) 282-8611.

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 DOI and CONFIRM that the insurance company or agent is legitimate and licensed in Delaware. If you believe you have been a victim of insurance fraud, call the DOI Fraud Prevention Unit toll-free at (800) 632-5154.