The following is a message from the OFIR:
In light of the continuing spread of the H1N1 virus, the Office of Financial and Insurance Regulation (OFIR) today encouraged Michigan consumers to plan for the flu season by reviewing their insurance policies.
“Knowing in advance whether your insurance covers a vaccination is just the first step in effective flu prevention,” OFIR Commissioner Ken Ross said.
Here are a few things Michigan consumers should find out in preparation for the flu season:
Health Insurance
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 your insurance? The seasonal flu vaccine and the H1N1 flu vaccine will usually be 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.
- 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.
- 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 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.
- 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.
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 Michigan Department of Community Health has comprehensive H1N1 Influenza information on its website at www.michigan.gov/mdch. Other web resources include: www.pandemicflu.gov and www.cdc.gov/swineflu/.
If you are unable to resolve any concerns you have about your health insurance with your insurance company, contact OFIR toll-free 877-999-6442 or www.michigan.gov/ofir
