While health insurers plan to cover administration of the H1N1 virus for the majority of their Maryland customers, insurance and health department officials would like to see them cover everyone.

Maryland’s Department of Health and Mental Hygiene (DHMH) is taking the lead in organizing the statewide reaction, working alongside the Maryland Insurance Administration to keep tabs on the response to H1N1 by the insurance industry.

Members of the DHMH and the MIA met with private insurers in August, giving them updates on the disease and plans for vaccinations. What came out of the meeting, according to Heather Hauck, director of the DHMH’s Infectious Disease and Environmental Health Administration, was a survey asking all insurers to outline their plans regarding if and how they will cover vaccinations.

At press time, insurers were still submitting their plans to the DHMH.

Beth Sammis

Beth Sammis, deputy commissioner for the MIA, said that she is hopeful the DHMH’s efforts to increase public access to the vaccine will be successful and the outbreak can be contained.

If, for whatever reason, Sammis said, the governor does declare a state of emergency in Maryland, the MIA received state approval for emergency procedures in August to assist consumers.

Under the orders, state insurance commissioner Ralph S. Tyler could enact several requirements for health carriers, including suspension of health benefit cancellations and nonrenewals, the waiving of any time restrictions on prescription medication refills and extending time frames for processing claims.

Calling for comprehensive coverage

UnitedHealth Group was one of the first national health insurers to say it would cover the administration of the H1N1 vaccine. The insurer has said it will cover the fee not only for members whose health benefit plans cover immunizations, including those in Maryland, but all of its members, regardless of whether it is part of their plan.

“We felt it was important to remove barriers to ensuring the widest possible administration of the vaccine,” Reed V. Tuckson, executive vice president and chief of medical affairs for the Minneapolis, Minn.-based company said in a statement.

Tyler Mason, a spokesman for the insurer, told IFAwebnews.com the company has set aside $50 million to cover H1N1 vaccinations as a preliminary measure.

That attitude is being applauded at the MIA, Sammis said, with the hope others follow UnitedHealthcare’s lead.

More vaccinations, the better

“There is clearly a public health reason to do this,” she said. “All of us will be better off if a maximum number of individuals are vaccinated and the fewer out-of-pocket costs the better. We are hopeful at the end of the day all carriers act as UnitedHealthcare has.”

Owings Mills, Md.-based CareFirst said in a statement to IFAwebnews.com that it will cover the administration of the H1N1 vaccine for its full-risk members and all self-funded accounts, unless otherwise directed by account members.

Some may pass on coverage

Kevin Kane, a CareFirst spokesman, said there may be a few that will not want the vaccination covered, such as those offering shots at their worksites.

“We have a letter out to those groups now asking for their instructions,”Kane said.

The insurer said it could not estimate the cost for covering the vaccination at this time, but it could be “substantial,” depending on how severe H1N1 and the seasonal flu impact its subscribers.

“Our medical staff is closely following the developing situation with regards to the incidence of H1N1 infection, as well as vaccine development, safety testing, availability and guidelines,” said a CareFirst statement regarding H1N1.

National insurers Aetna and CIGNA said they too will be covering the administration of the H1N1vaccine for Maryland customers.

‘Most’ to be covered

Aetna spokeswoman Wendy Morphew said the insurance company will cover members with health benefit plans that provide vaccination coverage, indicating that “most” Aetna members have such coverage.

Morphew said additional costs from the vaccinations will come in the second half of the year and the company has “built them into our planning.”

A CIGNA spokesperson said the company will cover the H1N1 vaccine under the preventative care benefit for all members, meaning “75 to 80% of our membership will be covered 100% without co-pays or insurance.”

All three companies said they are conducing public outreach through a variety of means to inform policyholders of their coverage, from telephone hotlines to website messages.

For an essay on pandemics preparedness by two of CIGNA’s  business managers in the insurers’ international benefits division, click here.

This story originally appeared in the October 2009 print edition of Insurance & Financial Advisor.