The recent novel influenza A (H1N1) pandemic has had a significant health impact on Texans. Texas has had 5,000 confirmed cases of the novel influenza A (H1N1) virus, including 271 hospitalizations and 33 deaths as of August 1, 2009. Events such as this pandemic highlight the need for increased preparation, particularly as the fall influenza season approaches. Based on the following guidelines that have been published by the Centers for Disease Control and Prevention and the federal Department of Health and Human Services, the Texas Department of Insurance (Department) strongly encourages group and individual health benefit plan issuers to help maintain the health of the community and minimize the financial impact of novel influenza A (H1N1) by:
- Ensuring the availability of the novel influenza A (H1N1) vaccine. A novel influenza A (H1N1) vaccine is expected to be available this fall. While the cost of the vaccine supply will be borne by the federal government, the cost of administering the vaccine will not. In order to ensure as many Texans as possible are vaccinated for novel influenza A (H1N1), the Department strongly encourages all group and individual health benefit plan issuers to consider covering the full cost of the administration of the novel influenza A (H1N1) vaccine, including copayments, coinsurance and deductibles.
- Covering the cost of the seasonal influenza vaccine. The Department strongly encourages all group and individual health benefit plan issuers to consider covering the full cost of the administration of the seasonal influenza vaccine, including copayments, coinsurance and deductibles, in addition to covering the cost of the vaccine. By ensuring as many Texans as possible are vaccinated for seasonal influenza, our health care resources will be better equipped in case of a widespread, severe novel influenza A (H1N1) outbreak.
- Providing access to antiviral medication. Access to antiviral medications that are indicated for influenza prophylaxis and/or treatment is important in shortening the length of illness and preventing the hospitalization of certain high risk individuals. The Department encourages all group and individual health benefit plan issuers to review and augment drug coverage and formulary requirements to ensure access to these antiviral medications, and also strongly encourages all group and individual health benefit plan issuers to consider covering the full cost of the administration, including copayments, coinsurance, and deductibles.
- Delivering educational information. Educating enrollees and employees about the availability of vaccines, the symptoms of influenza, and protection strategies will help prevent the spread of influenza. Websites that may be helpful include:
- CDC: http://www.flu.gov and http://www.cdc.gov/h1n1flu/
- Department of State Health Services: http://www.texasflu.org
- TDI: http://www.tdi.state.tx.us/health/cpmh1n1flu.html
- CMS: http://www.cms.hhs.gov/Emergency/10_PandemicFlu.asp.
- Creating or updating their business continuity plans. In the midst of a pandemic, the functioning of group and individual health benefit plan issuers is critical to our state's infrastructure. Thus, the Department strongly recommends that group and individual health benefit plan issuers have a plan in place for such a public health emergency.
The federal Department of Health and Human Services and the Centers for Disease Control and Prevention have developed a Health Insurer Pandemic Influenza Planning Checklist, which the Department encourages group and individual health benefit plan issuers to utilize in their planning. The checklist is available at http://www.pandemicflu.gov/plan/workplaceplanning/healthinsurer.html
Questions regarding this bulletin should be directed to: Margaret Lazaretti, Senior Policy Advisor, at Margaret.Lazaretti@tdi.state.tx.us.
Mike Geeslin
Commissioner of Insurance