Date: October 15, 2009
For more information contact: Jim Guidry, (608) 264-6239 or jim.guidry@wisconsin.gov

Commissioner Urges Consumers to Prepare for Flu Season

Madison, WI—In light of the continuing spread of the H1N1 virus, Wisconsin Insurance Commissioner Sean Dilweg encourages consumers to prepare a flu response plan this year.

"A second wave of H1N1 is expected by the World Health Organization," said Dilweg. "Consumers should review what steps to take in the event that the flu strikes you or your family."

The first step in making a flu response plan is a comprehensive review of your insurance policies. Here are a few things you should look for:

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 to be able to answer the following questions:

Is the vaccination covered by my insurance?

A vaccine for the H1N1 strain of flu is now available, 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, health care 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.

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-payment for the H1N1 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.

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 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.

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/.

If you are unable to resolve any concerns you have about your health insurance with your insurance company, contact OCI at oci.wi.gov or by calling OCI at 1-800-266-3585.

Created by the Legislature in 1871, Wisconsin's Office of the Commissioner of Insurance (OCI) was vested with broad powers to ensure that the insurance industry responsibly and adequately met the insurance needs of Wisconsin citizens. Today, OCI's mission is to lead the way in informing and protecting the public and responding to its insurance needs.