If you have been following the news lately, you probably know that the Centers for Disease Control (CDC) has released information that indicates that the H1N1 vaccination will be available this fall. The CDC has identified individuals who are at a higher risk of getting H1N1 or experiencing complications if they do get H1N1. This includes:
- Pregnant women
- People who live with or care for children under the age of six months
- Health care and emergency medical services personnel
- Persons six months through 24 years of age
- People age 25 through 64 years of age who have chronic health conditions or a compromised immune system.
The CDC has advised health care providers that the H1N1 vaccination is intended to be used along with the seasonal flu vaccine. For more information from the CDC about the H1N1 vaccine, please go to www.cdc.gov/media.
Your Benefits
We are aware of the increasing number of cases of H1N1 being reported by the World Health Organization (WHO) and realize the importance of providing coverage for the H1N1 vaccination to our members. Current information from the CDC indicates that providers are not to charge for the vaccine but may charge for the administration and related care. To ensure our members get the care they need, we have amended our coverage for 2009. In 2010, benefits for the H1N1 vaccination will be part of your Service Benefit Plan coverage. Benefits will be provided in 2009 and 2010 when the vaccine is administered according to the recommendations of the CDC and any applicable US Food and Drug Administration (FDA) approvals.
Standard Option and Basic Option preventive care benefits will be provided in 2009 and 2010 the same as other covered immunizations and vaccinations. Both Standard and Basic Option benefits will be available for services performed by both Preferred and Non-preferred providers. We are waiving the requirement to use Preferred providers only for Basic Option for the H1N1 vaccine. However, if you use a Non-preferred provider, you may be responsible for the difference between our payment and the provider's charge. Please refer to your 2009 and 2010 Service Benefit Plan brochures, Section 5(a) for more information about benefits for this vaccination.