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Guidance on health insurance for swine flu vaccinations

By Lydell C. Bridgeford
October 6, 2009

The Employee Benefit Research Institute issued a Q&A fact sheet that highlights information some employers may find helpful about health insurance coverage for H1N1 and seasonal flu shots.

On Monday, the Centers for Disease Control and Prevention launched a national campaign to immunize at least half the U.S. population against the new H1N1 virus

The government purchased about 250 million doses of the vaccine at a cost of $2 billion.

Officials at EBRI, a nonpartisan group, believe that the approach of the seasonal flu and warnings about an H1N1 flu pandemic has raised questions about employment-based health coverage and H1N1 shots. Consequently, EBRI compiled responses to questions employers may have about H1N1 vaccinations and health insurance. For example:

Q: Will insurance plans cover H1N1 flu shots?

A: This year, the government is paying for the cost of the H1N1 vaccine. Large insurers in Missouri and Illinois have announced they will cover all H1N1 flu shot costs (including physician fees), and others may follow.

Q: Are seasonal flu shots covered by employer-based health coverage? 

A: Coverage may be part of insurance plans, but this is a matter negotiated between employers and insurers. Employees should check with their insurer to determine coverage for flu shots and what co-payments may apply.

Q: Are there options for obtaining free seasonal or H1N1 shots if my insurer does not cover them?

A: The situation is evolving, but press reports indicate local officials in many areas are trying to organize clinics at schools and other places. The timing and availability may depend, in particular, on the availability of the H1N1 vaccine. Your local health department is a good place to check for information.

Q: Where can I get more information about the H1N1 flu and preparations to address it?

  • Information about the seasonal and H1N1 flu is not only posted on the CDC’s Web site, but also on the U.S. Department of Health and Human Services’ Web site.  
  • The World Health Organization, which has declared the global spread of the H1N1 flu to be a flu pandemic (a widespread epidemic that affects people in many different countries), has numerous documents on its Web site about the flu.

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