Wednesday, April 18, 2007

Insurance coverage during an influenza pandemic

"The federal government recently urged the health insurance industry to gird itself for business continuity, protect its employees, and consider changing certain practices to help enrollees get and pay for care during an influenza pandemic.

In a checklist released Mar 21, the US Department of Health and Human Services (HHS) encouraged health insurers to provide cross-training for employees, prepare retirees to backfill essential roles, and contract with temporary staffing agencies.

Among practices and policies that HHS recommends insurers consider during a pandemic to maintain "access to healthcare and health insurance coverage" are:

- Deferring rate increases
- Temporarily suspending business rules for prior medical authorization, precertification, and pharmacy refill limitations
- Extending time periods for filing claims
- Waiving copayment obligations

Among insurers working on business continuity plans, Indiana-based WellPoint Inc., which provides healthcare benefits to approximately 3.2 million people, says it will comply with all state and federal regulatory guidelines, including those that could override benefit language.

At Regence BlueCross BlueShield of Oregon, spokeswoman Samantha Meese says her organization agrees that topics outlined in the HHS checklist need to be addressed. Regence is consulting with the BlueCross BlueShield Association, America's Health Insurance Plans (a national lobbying association based in Washington, DC), and HHS to ensure their organizations can work together during an outbreak.

Kevin Goodlin, a senior manager in Deloitte Touche Tohmatsu's Global Security Office, brings a different point of view to the discussion. Whether employees are insured or not will not matter in a pandemic, he says. "Since healthcare is in finite supply, having health insurance may not be enough in a major pandemic," he says. Deloitte encourages employees to buy supplies of over-the-counter medicine, order more than a month's supply of prescription drugs, and ask their doctors about antivirals such as Tamiflu".

Source: Apr 12, 2007 (CIDRAP Source Weekly Briefing)

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

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