Date: May 1, 2009
For more information contact: Jim Guidry, (608) 264-6239 or jim.guidry@wisconsin.gov

Influenza Outbreak Could Affect Insurance Coverages

Madison, WI—With the threat of a flu pandemic facing the nation and the world, Insurance Commissioner Sean Dilweg is encouraging Wisconsin consumers to make sure they understand the terms and conditions of their health insurance and other policies before they become ill.

"Consumers should be aware of conditions in their policies that come into play if you need to visit the doctor or be admitted to the hospital," said Dilweg.

According to Dilweg it is always important to understand the conditions of one's health insurance policy, but with a possible increased demand for health care, it is crucial that consumers be even more aware of policy coverages. Take a few minutes and answer these questions:

• Does your policy have a preauthorization requirement for hospital admission or other services?
• What is your co-payment for the most common H1N1 treatments? The two drugs doctors can prescribe to treat H1N1 flu are Tamiflu and Relenza. Also find out if there are any coverage limitations that apply to the distribution of the medication. Some policies will restrict coverage on the number of doses per prescription or per year.
• What is your out-of-network co-payment? If your area is heavily affected by the spread of the H1N1 flu outbreak, your regular physician may not be able to see you in a timely manner. If you have to go out-of-network, be aware you will have to pay a higher co-payment for your office visit and possibly any tests run during the visit.

Get prepared for any eventuality with the following checklist:

• Have your health insurance I.D. card handy.
• Review your health insurance policy provisions. Know which doctors and hospitals are in your network.
• Make note of your co-payments. Know how much a doctor's office visit will cost. Check to see if your co-payments go up if you go out-of-network.
• Find the list of pharmacies covered by your health insurance policy.
• If you have plans to travel, make sure you check to see if there are any doctors or medical facilities in-network where you will be visiting.
• Make sure you have contact details for your health insurance company available in case you have questions.

Dilweg encourages consumers to have all their insurance information in an easily accessible location so that every family member will be able to locate it as needed. Employees should consult with their employer if they have questions about their employer-sponsored health insurance. People can also contact their health insurer for more details.

Consumers should also take care to review other insurance policies for coverage in the event a pandemic impacts their lives or livelihoods. Travel plans, for instance may become altered. If you have planned a trip to Mexico and have travel insurance, you might be considering cancelling your trip. However, travel insurance policy language is typically specific and may not cover epidemic or pandemic situations. Review your policy and check with the insurance company that issued the policy to see if you are covered.

Business owners with business interruption insurance coverage might be concerned about having to shut down their operations due to an outbreak or absenteeism. Commissioner Dilweg encourages business owners to check their interruption policy to see what eventualities will trigger coverage under their plan.

Consumers with insurance questions are encouraged to contact OCI at 1-800-236-8517.

Created by the Legislature in 1871, Wisconsin's Office of the Commissioner of Insurance (OCI) was vested with broad powers to ensure that the insurance industry responsibly and adequately met the insurance needs of Wisconsin citizens. Today, OCI's mission is to lead the way in informing and protecting the public and responding to its insurance needs.