Major Illinois Health Insurers Agree to Cover Administration of H1N1 Flu Vaccination

From the Illinois Department of Insurance
October 27, 2009

CHICAGO – The Illinois Department of Insurance announced today that Illinois’ largest private health insurers and HMOs have voluntarily agreed to cover administration costs associated with the H1N1 flu vaccine. The Department encouraged first-dollar coverage for the vaccine.

Aetna, Blue Cross and Blue Shield of Illinois, CIGNA, Health Alliance, Humana, PersonalCare, Unicare, and UnitedHealthcare will cover the cost of administration for the H1N1 vaccine for all of their policyholders. The cost of the vaccine itself, now available at local health departments and hospitals in Illinois, is being paid for by the U.S. Department of Health and Human Services.

“As parents of young children, pregnant women, and other vulnerable Illinoisans take steps to protect against the spread of the H1N1 virus, it is important for consumers to know whether the H1N1 vaccine is a covered health insurance benefit,” said Michael T. McRaith, Director of the Illinois Department of Insurance. “We applaud these Illinois insurers for taking voluntary, proactive measures to reduce financial barriers to accessing the H1N1 vaccine.”

Many smaller insurance companies will also cover the administration costs of the H1N1 vaccine for all or most of their policyholders. The Department advises all consumers to contact their insurance company, insurance agent, or employer to inquire about the details and limits of coverage for the H1N1 vaccine. Consumers in need of information or assistance can also call the Department’s Office of Consumer Health Insurance toll-free at (877) 527-9431.

The Department offers additional advice for consumers to keep in mind as they prepare for the flu season:

Review Your Insurance Policy
It is 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:

• Do you 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 seasonal flu and H1N1 vaccine and what the cost will be.
• Will your policy cover administration of the H1N1 vaccine regardless of where you receive the vaccine?
• Some health insurance companies may cover the administration cost of the vaccine only if it is delivered by a network provider.
• 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.

Plan Ahead
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.

Take Appropriate Preventive Measures
The Illinois Department of Public Health (IDPH) lists public H1N1 vaccination sites, clinic times, and additional information on the 2009 H1N1 flu at www.ready.illinois.gov. For non-medical questions about the H1N1 virus, call the Illinois Flu Hotline at (866) 848-2094 or (866) 241-2138 (Spanish).

The Department’s mission is to protect consumers by providing assistance and information, by efficiently regulating the insurance industry’s market behavior and financial solvency, and by fostering a competitive insurance marketplace. The Department assists consumers with all insurance complaints, including life, health, auto and homeowners. Consumers in need of information or assistance should visit the Department’s Web site at www.insurance.illinois.gov or call our Office of Consumer Health Insurance at (877) 527-9431.

Report Shows Small Businesses Lack Choices in Health Insurance Market

From the Office of U.S. Senator Dick Durbin

[WASHINGTON D.C.] – Assistant Senate Majority Leader Dick Durbin (D-IL) and Senators Olympia J. Snowe, Ranking Member of the Senate Committee on Small Business and Entrepreneurship, Christopher S. Bond (R-Mo.) and Blanche L. Lincoln (D-Ark.) today announced the release of a Government Accountability Office (GAO) report that highlighted a lack of competition in the small group health insurance market, leaving American small businesses with few choices when it comes to securing meaningful, affordable health care coverage options for their employees. The lawmakers requested the report from GAO, which confirmed the consolidation of the small group health insurance marketplace has increased markedly. Specifically, the report found that the five largest carriers in the small group market, when combined, represented at least three-quarters of the market in 34 of the 39 states responding to the survey, and they represent 90 percent or more in 23 of these states.

“Competition is crucial to making health insurance more affordable for small businesses,” said Senator Durbin. “But in my home state of Illinois, competition is scarce – the five largest insurance companies own eighty-two percent of the market. Nationwide, this problem is growing and health insurance is becoming increasingly unaffordable for small business owners. I plan to join with Senators Snowe and Lincoln to reintroduce legislation – The Small Business Health Options Program (SHOP) Act – that will increase competition and bring down the cost of health insurance for small businesses. As uncertainty about our economic future remains, I hope Congress will make this legislation a priority during the health care reform debate.”

“Access to affordable health insurance remains a top concern for small businesses in Maine and across the country, and this GAO report provides stark data highlighting the challenges we still face in confronting this crisis,” said Senator Snowe. “The sad truth remains that small group insurance markets continue to lack real competition among insurers. No competition means higher costs, and higher costs translate to no health insurance. That’s why I am working with Senators Durbin, Lincoln, and others to re-introduce the Small Business Health Options Program Act, or SHOP Act. This legislation would inject much-needed competition into dysfunctional insurance markets, and provide a range of affordable new coverage options for small businesses and the self-employed.”

“It’s Economics 101, less competition in health insurance will mean fewer choices and higher costs,” said Senator Bond. “Congress should act now to make it easier for our small businesses to provide workers and their families with health insurance.”

“The majority of uninsured Americans are self-employed individuals and employees of small businesses,” Senator Lincoln said. “I’ve heard from several small business owners in Arkansas who desperately want to offer health insurance to their employees because they know it helps with recruitment, retention, employee performance, and the overall success of the business, but they have found it increasingly unaffordable. Our bipartisan SHOP bill will allow us to begin to address the needs of the millions of working uninsured Americans whose top priority is access to quality and affordable health care for their families.”

The GAO report found that:

• The median market share of the largest small group carrier has increased to about 47 percent in 2008 from the 43 percent reported in 2005 and the 33 percent reported in 2002. Twenty-four of the 29 states providing information in both 2002 and 2008 saw increases in the market share of the top carrier that ranged from about 2 to 39 percentage points.
• The number of states with a combined market share of the five largest carriers of 75 percent or more has also increased since our 2002 survey. The combined market share of the five largest small group carriers represented three-quarters or more of the market in 34 of 39 states, compared to 26 of 34 states reported in 2005 and 19 of 34 states reported in 2002.
• Finally, the median market share of all the Blue Cross and Blue Shield carriers in 38 states reporting this information in 2008 was about 51 percent, compared to the 44 percent reported in 2005 and the 34 percent reported in 2002 for the 34 states supplying information in each of these years.

To view a complete copy of the report visit: www.gao.gov.