Insurance

H1N1 and Health Insurance

The health insurance angle to the swine flu pandemic in the United States is amazing.

Very few average people are considering their health insurance, because it is not as interesting or exciting as the issues around the symptoms and treatment of the illness.

However, medical insurance is an issue that many public health officials and journalists are concerned about. The National Association of Insurance Commissioners is encouraging consumers to review their health care plans as they relate to the so-called Swine Flu.

Many state health agencies are urging people to check their insurance, and, in fact, the information on this page is largely drawn from health insurance checklists drawn up by the states of Ohio and Michigan.

Kathy Kristoff of CBS Moneywatch notes that, “Those who do have insurance are finding that their coverage varies widely, with some companies covering the treatment in full and others demanding large co-payments.”

According to another recent report California insurance companies deny an average of 21% of all claims, so you need to know your coverage.

Understand Your Health Insurance coverage

It’s always important to understand just what you health insurance policy covers, but with the potential for an increased demand for health care services, you need to be even more aware of your specific plan details. Read your policy carefully and consider the following questions:

• Do you have a cost-sharing responsibility for flu vaccinations? Many health insurance policies have co-payments for seasonal flu vaccinations.
• Ask your insurance company if you will have a co-pay for the seasonal flu vaccine and what the cost will be.
• Is the vaccination covered by your insurance? The seasonal flu vaccine and the H1N1 flu vaccine are normally administered separately. The U.S. government is covering the cost of the H1N1 vaccine, but you may be charged its administration. Check with your insurance company to see if your coverage includes the seasonal flu vaccine and extends to the administration of the H1N1 vaccine.
• 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.
• 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.
• Check with your insurance company to determine if you have coverage for vaccines received at drug stores, employers’ offices and schools. Some health plans, including Medicare Advantage plans, only provide coverage for vaccines received from designated providers.

Be prepared in case you or a family member do become infected:

• 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.
• Keep handy a list of pharmacies and medications covered under your 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.
• 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.

Best Bets For H1N1 Coverage

However, some insurance companies are taking action positive action. Tim Bireley, VP, Guardian Group Medical, the health insurance division of the Gaurdian Group Life Insurance Company of America said, “Guardian decided to cover the costs associated with administering the vaccine…” That’s a very good sign if you are covered by the Guardian, but you are still only covered for actual treatments if you become ill with Swine Flu under the specific provisions of your individual plan.”

Aetna, United Health Care, and several other companies have also made similar decisions, but you should definitely review your policy.

Here’s a report from the state of Texas on what H1N1 related expenses insurance companies in that state are covering: Texas Health Insurance Companies

Short Term Insurance

You might also consider a short term plan if you are uninsured or short term additional coverage if you are already insured, particularly from one of the companies that have said the y will cover H1N1 expenses.

If you fill out a short application eHealthInsurance can give you a free quote.  They examine the rates from dozens of companies, so it can save you a lot of effort.  More, importantly it can give you a little peace of mind about your coverage.

You will get a lot of quotes back, but compare them with the companies on the document from the Texas Department of Insurance.  Then you should have some security about what you are actually buying.