What you need to know about:
Background
The U.S. Centers for Disease Control and Prevention (CDC) and its partners are developing a vaccine for the 2009 H1N1 influenza virus (also known as "swine flu"). We anticipate the vaccine will be available early October. Priority Health is carefully monitoring the CDC's progress and recommendations for 2009 H1N1 vaccinations.
Priority Health's seasonal flu and 2009 H1N1 flu vaccine and treatment coverage
We understand it's important to keep your employees healthy, so we have made the following coverage decisions:
Vaccinations
- Members (and their dependents) with vaccine coverage will be eligible to receive both the seasonal flu vaccine and the H1N1 vaccine when it becomes available.
Go to the chart explaining what locations offering flu shots are covered
- Members with vaccine coverage will pay no copays to obtain the vaccine at in-network providers, as well as at selected participating pharmacies.
- We will allow direct-to-member reimbursement for the vaccine cost at any out-of-network provider. (If members receive the vaccine from an out-of-network provider, copay/coinsurance may apply.)
- We're asking physicians to follow CDC vaccine guidelines so members most at risk from influenza are vaccinated first.
Note: A small group of plans do not have vaccination coverage and will not be eligible for this benefit.
Treatment
- We also cover treatment of 2009 H1N1 flu just like we do for seasonal flu.
- To help members with more severe symptoms obtain treatment more quickly, we are continuing to lift the preauthorization requirements for the antiviral medications Tamiflu® and Relenza®.
- We're asking physicians to follow CDC guidelines for these drugs since every instance of influenza is not appropriate for antiviral therapy.
Helping employees stay healthy and minimizing effects of employee absenteeism
Steps you can take to keep your employees healthy and your business running:
- Review and/or develop plans to maintain business continuity. These may include: reviewing business operations to identify minimum staffing requirements and key roles, encouraging cross-training of staff and exploring opportunities for employees to work from home if necessary.
- Send home employees who show signs of influenza-like illness. Encourage sick employees to stay home and allow flexible leave policies to enable employees to care for sick household members or children affected by school or daycare center closures. The CDC recommends that you do not require employees to present physician verification of illness so as not to strain the capacity of physician offices.
- Encourage workplace practices to limit the spread of disease. These can include frequent hand washing and/or use of alcohol-based hand sanitizers, covering coughs and sneezes and cleaning hard surfaces that come into physical contact with employees or customers. Consider providing well-placed reminder signs, tissues and touch-free waste receptacles to encourage good respiratory and hand hygiene.
Preparing a business plan for widespread flu outbreak
The CDC has developed extensive resources to help businesses plan and prepare for widespread influenza this fall and winter:
Last modified
05/20/10
