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Cost of Care: Dallas sees no relief in health care expenses as competition drives up costs
Medical care in Dallas is delivered in a broken market where doctors, hospitals and other providers shower patients with services of diminishing value but staggering cost. Read more...

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Important Update on H1N1 (Swine) Flu Vaccine Coverage

September 17, 2009 : The secretary of Health and Human Services has renewed the declaration that a nationwide public health emergency exists in relation to the H1N1 virus. The Centers for Disease Control (CDC) has designated vaccination as the most powerful public health tool for control of influenza.

In keeping with our mission to improve the health, well-being and sense of security of our customers, CIGNA will communicate to our fully insured clients that we will cover H1N1 flu shot administration in any setting at 100 percent of the Medicare allowable rate.1 Deductibles will not apply – covered individuals will not be asked for a copay or coinsurance. Self-insured clients have the option to opt-out of this process. This will be CIGNA's standard approach until the potential for an emergency situation subsides.

This communication relates to the swine flu vaccine called H1N1 only. Coverage for other vaccines will be in accordance with the individual's plan.

Because the federal government will be paying for the vaccine itself, CIGNA and other private health plans will only be asked to reimburse for the administration of the vaccine. We expect that both the traditional (i.e., physician offices) and non-traditional (e.g., health fair and retail pharmacy) sites will be used as distribution centers for the administration of the H1N1 vaccines.

By providing first dollar coverage, CIGNA is supporting the CDC recommendations and stressing the importance of making every effort to provide vaccination to appropriate individuals across the country. Self-insured clients who do not wish to have 100 percent coverage must notify their CIGNA representative by October 9, 2009.

For additional information, please contact your CIGNA representative.

1 The estimated cost of administering the H1N1 flu vaccine is approximately $21 depending on the geographic location.

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UnitedHealthcare to Cover H1N1 Flu Vaccine for its Members

As you may have read, all regions of the U.S. have now reported positive cases of the H1N1 flu. The latest comments from the Centers for Disease Control and Prevention (CDC) suggest the situation remains fluid.

UnitedHealthcare will provide coverage for the administration of the H1N1 (swine flu) vaccine for all members covered by its fully insured plans.

We intend to process all self-funded member claims as a covered service unless clients explicitly direct us otherwise. If your client's plan does not currently cover the administration of the vaccine, and you notify us of your client's intent not to cover the vaccine in the future, UnitedHealthcare will reimburse the cost of the administration of the vaccine. The federal government has said that the vaccine will be provided at no cost to health care providers.

UnitedHealth Group will coordinate its efforts with federal and state authorities to ensure the widest possible administration of the vaccine in an effort to mitigate the potential consequences of an H1N1 pandemic.

Based on its analysis of the current situation, The CDC's Advisory Committee on Immunization Practices has recommended prioritizing the following population segments to receive the vaccine:

• pregnant women;
• caregivers for children younger than 6 months of age;
• health care and emergency medical services personnel;
• children and young adults from 6 months through 24 years old; and
• persons aged 25 through 64 years who have underlying health conditions that might increase their risk for flu-related complications.

Other population segments will be able to receive the vaccine, as it is made available.

Prescription Coverage
Antiviral therapy is an important part of the prevention and treatment of H1N1 flu. For clients that have UnitedHealthcare prescription benefit plan managed through UnitedHealth Pharmaceutical Solutions, Tamiflu® (oseltamir) and Relenza® (zanamivir) are covered drugs. The drugs are also covered under legacy PacifiCare and UnitedHealthcare prescription benefit plans administered by Prescription Solutions, which have lifted all prior authorization requirements until further notice.

Member Frequently Asked Questions (FAQ)
To better inform members and help answer common questions, we have developed an H1N1 member FAQ, that can be accessed at myuhc.com. The FAQ is updated frequently with the latest guidance from the CDC.

Business Continuation Preparedness
We want to reassure clients that if this situation escalates, UnitedHealthcare is fully prepared to initiate our business continuation program, which is designed to minimize any type of service disruption.

For More Information
For the most up-to-date information, please visit the CDC's Web site www.cdc.gov/h1n1flu/.

We will continue to keep you updated as new information is made available. You may also visit our Web site, www.uhc.com, for the most up-to-date information.

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Health Coverage, Security Most Important in Choosing Job
By Kathy Gurchiek

It really is not all about the money.

Health insurance is the most important factor in choosing a job, say 84 percent of 1,200 U.S. adults age 18 and older in a new poll from the Washington, D.C. based Center for State & Local Government Excellence.

Job security and working in an environment with clear policies and procedures are the second most important, while pay trailed in 10th place and the amount of vacation time ranked last.

The phone survey, conducted in English during October and November 2007, asked respondents to rank in importance a list of 15 workplace benefits and characteristics that they consider when choosing a new job. The rankings were:

• Health insurance plan, 84 percent.
• Job security, 82 percent.
• Environment with clear policies and procedures, 82 percent.
• Retirement or pension plan, 76 percent.
• Flexible, family-friendly workplace, 71 percent.
• Getting quick decisions on work issues, 69 percent.
• Working with talented managers, 68 percent.
• Potential for promotions, 66 percent.
• Being creative and intellectually stimulated, 66 percent.
• Amount of total compensation, 65 percent.
• Making a contribution to society, 64 percent.
• Reasonable work commute, 63 percent.
• Having independence and personal autonomy, 57 percent.
• Working with others from diverse backgrounds, 50 percent.
• Amount of vacation time, 46 percent.

There are some differences among demographic groups, the survey found, and differences that reflect the type of employer a respondent works for - private business, nonprofit or government.

The retirement plan is very important to 84 percent of government employees, 72 percent of those at private employers and 73 percent of those at nonprofits, according to the report.

The money is more important to workers in private business (70 percent) than government workers and those at nonprofits (59 percent and 58 percent, respectively). Making a contribution to society scored higher in importance among government workers and those at nonprofits (74 percent and 71 percent, respectively) that those in private business (58 percent).

As might be expected, there were some generational differences, with 74 percent of Generation X workers ranking the potential for promotions higher than baby boomers (58 percent). Generation X also tended to rank job security as more important that boomers (88 percent vs. 79 percent).

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Medication Users Can Cut Pill Costs Themselves - Literally
By Health Care News

While we wait for politicians to solve our prescription drug problem- or, perhaps more likely, make it worse- there's something every person using medication can do right now to cut costs: Cut pills.

No, I don't mean people should take fewer pills- I'm not dispensing medical advice. I mean that those who regularly use medications should buy bigger pills and cut them in half.

Drug companies make pills in various sizes. Moreover, they score many pills, to make it easier to cut them. A pill that is twice the size of your prescription pill is not twice the cost. Sometimes it costs only a little bit more, or even the same. Cut it in half, or in a quarter, and you can save big. 

You can invest in a five dollar pill cutter, purchase the larger-sized pills, and fill your prescription- and, according to an astute listener to my radio program, reduce your drug bill by a third without even having to substitute one brand of another. 

Many people do it. In fact, drug companies expect it, which is why they score the pills. It doesn't work for every pill, and you should, of course, consult your doctor before initiating such a plan. But if your doctor has sense, he or she will cooperate.

Of course, not every professional has thought the matter through. Curtis Kellner, pharmacy director at the University Hospital and Medical Center at Stony Brook, New York, admits pill-splitting can work. But not everyone can or should do it, he argues. People with poor vision or arthritis, for example, may have difficulty splitting their pills. "I can't imagine my own folks splitting tablets," Kellner said. 

What Kellner forgets is that this is why people have neighbors, social workers, grandkids, or even pharmacist sons to help them out with things like that. A little common sense is a lot less expensive than a government bureaucracy. 

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MSAs Are Not FSAs Are Not HRAs
By Health Care News

Faced with alarming increases in health care costs, employers are turning to consumer-driven health plans to help rein in expenditures. Read more...

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Understanding Health Savings Accounts
By Health Insurance Underwriter

If you are like most health insurance agents and brokers, you are no doubt aware of the publicity given to consumer-driven health plans, also known as defined contribution (DC) plans, health reimbursement arrangements (HRAs) and, lately, health savings accounts (HSAs). It is a real alphabet soup of health insurance. For our purposes, we will reference these programs as HSAs after the IRS guidelines. If you are not already familiar with these acronyms, you should be. Read more...

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Implementing HIPAA
By Health Insurance Underwriter

HIPAA Administrative Simplification Rules comprise an incoming wave of regulations and requirements engulfing health care in a slowly rising tide of compliance-related action. For an update on compliance progress, here is a report from those on the frontlines of the compliance effort. Read more...

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