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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. 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.
- 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.
Business Interruption
Insurance
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.
More Information
The federal government has created a Web site with
information: www.pandemicflu.gov.
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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