Dear member:
Earlier this year, the World Health Organization and the United States Centers for Disease Control (CDC) alerted the public to the pandemic nature of a different type of influenza (flu). This new type of flu is called the 2009 H1N1 Flu. It is also known as the Swine Flu. Vaccines to prevent the 2009 H1N1 Flu should be available this fall; however, the CDC advises the H1N1 vaccine will not replace the seasonal flu vaccine. It is important that you should receive both vaccines if recommended by your doctor or health care professional.
Benefit Availability:
In 2009, when you receive the vaccine as recommended by the CDC and the U.S. Food and Drug Administration, we will provide Preventive Care benefits as stated below.
Standard Option member responsibility for services provided to an adult:
- Preferred physician, other health care provider, or outpatient facility clinic: you pay a $20 copayment for the associated office visit (no deductible); nothing for the immunization
- Participating/Non-participating physician, other health care provider, or outpatient facility clinic*: you pay 30% of the Plan allowance
*For Non-participating providers you are also responsible for any difference between our allowance and the billed amount
Basic Option member responsibility for services provided to an adult:
- Preferred/Participating/Non-participating* primary care provider, other health care professional, or outpatient facility clinic: you pay a $25 copayment for the associated office visit; nothing for the immunization
- Preferred/Participating/Non-participating* specialist provider: you pay a $30 copayment for associated office visits; nothing for the immunization
*For Non-participating providers you are also responsible for any difference between our allowance and the billed amount
Basic Consumer Option member responsibility for services provided to an adult:
- Preferred/Participating/Non-participating provider, including outpatient clinics*: you pay nothing
*For Non-participating providers you are responsible for any difference between our allowance and the billed amount
Standard Option member responsibility for services provided to a child up to age 22:
- Preferred/Participating/Non-participating provider, including outpatient facility clinics*: you pay nothing (No deductible)
*For Non-participating providers you are responsible for any difference between our allowance and the billed amount
Basic Option and Basic Consumer Option member responsibility for services provided to a child up to age 22:
- Preferred/Participating/Non-participating provider, including outpatient facility clinics*: you pay nothing
*For Non-participating providers you are responsible for any difference between our allowance and the billed amount
In states permitting pharmacists to administer the H1N1 vaccine, Service Benefit Plan members may receive the vaccine at no cost in 2009, at a Preferred retail pharmacy that participates in our vaccine network. Our vaccine network is a network of Preferred retail pharmacies that have agreements with us to administer specific immunizations. You can find a participating pharmacy here . Please note that you will pay all charges for vaccines administered in a Non-preferred retail pharmacy.
Prevention of the Flu and its Spread:
The following are important actions to prevent spreading the flu. The flu spreads from person to person primarily by coughing and sneezing. It is important to:
- Wash your hands with soap and water frequently, especially after coughing or sneezing, and before eating or touching your mouth, nose or eyes;
- Cover your mouth and nose with a tissue when you cough; and
- Avoid contact with others who are sick.
If you become sick, the CDC recommends you stay at home and avoid contact with others for at least 24 hours after the fever is gone. People who develop the flu and have chronic medical conditions, young children, are pregnant, are age 65 and older, and/or are immunosuppressed; and people with severe flu symptoms should contact their primary health care provider. More information from the CDC is available at www.cdc.gov and
www.flu.gov.
The CDC has also issued a warning regarding advertisements for products that prevent, cure, treat, or diagnose H1N1 flu. Products carrying these fraudulent claims may be promoted as dietary supplements, drugs, vaccines, or diagnostic tests. Members should discuss any questions or concerns they have regarding diagnosis, treatment, or prevention of the flu, including questions regarding receipt of the H1N1 or seasonal flu vaccine, with their health care provider.
Information and updates regarding benefits available for the vaccine, along with information regarding the 2009 H1N1 flu and the seasonal flu, are available from our website www.fepblue.org. If you have questions regarding benefits, please call us at the number on the back of your identification card. You may also call us at Blue Health Connection, our 24/7 Nurse Advise Line (1-888-258-3432, Option 1), with your questions regarding the 2009 H1N1 flu and the seasonal flu.
Wishing you good health,
Your Service Benefit Plan