Governor Corzine Announces Landmark Flu Vaccine Coverage

Health Insurers agree to pay providers for H1N1 influenza vaccination administration

TRENTON - Meeting his commitment to ensure provider coverage of H1N1 vaccines, Governor Jon S. Corzine today announced a cooperative effort with New Jersey's major health insurers that put the state and its citizens at the forefront of handling a possible resurgence of the H1N1 influenza this fall. The Governor and New Jersey Department of Banking and Insurance (DOBI) Commissioner Neil N. Jasey have secured an unprecedented commitment for coverage of New Jersey citizens by medical providers licensed to administer the H1N1 vaccination as well as coverage of other H1N1 influenza medications. 

"This sweeping agreement by health insurers to cover H1N1 influenza vaccinations is yet another sign that New Jersey is presenting a united front in its aggressive approach to prepare its citizens for possible emergencies," Governor Corzine said. "New Jersey has once again demonstrated its leadership role in preventative medicine and health coverage for its citizens at a critical time." 

While the federal government will pay the cost to produce the H1N1 influenza vaccination currently under development, payment to administer the vaccine has remained an open issue. Today's agreement closes the gap in New Jersey for distribution of the H1N1 vaccination once it becomes available. 

"Cooperation by New Jersey's major health insurers to address this serious public health issue is an indication that when it comes to our citizens' care, we are all on the same page," said Commissioner Jasey. "Our healthcare insurance carriers are to be commended for helping us to secure this landmark agreement that helps us ensure safe workplaces, keep schools open, keep commerce flowing and, our top priority, help families remain safe." 

"New Jersey's health insurers have recognized the H1N1 influenza as an urgent public health issue and have recognized a responsibility to cover the administration costs for the vaccine, in many cases regardless of the specific plan of benefits.  Our member plans will continue to work collaboratively with the State and the provider community to tackle this important threat to public health," said Ward Sanders, president of the New Jersey Association of Health Insurance Plans. 

The highlights of the agreement include:

 

• Coverage of vaccine administration whether or not the plan provides it, including cases where the insured has exhausted his or her annual wellness allowance, which is ordinarily subject to a fixed dollar limit.

 

• Reimburse any member provider for vaccine administration, including OB-GYNs and specialists, whether or not the provider is the insured's Primary Care Physician.

 

• Waive any restrictions on multiple flu shots (including restrictions emanating from exhausting a wellness allowance).

 

• Coverage of anti-viral medications (e.g. Tamiflu and Relenza) and the relaxation of certain restrictions on their use so that doctors can provide the medications consistent with evolving federal guidance.

 

• Carriers will review their claims processing systems and institute measures, such as manual overrides, to prevent coverage denials and related paperwork burdens and other delays in the above situations.

 

Joining this multi-point agreement are: Aetna, AmeriGroup, AmeriHealth, CIGNA, HealthNet, Horizon Blue Cross Blue Shield of New Jersey, UnitedHealthCare, and University Health Plans. 

The H1N1 vaccine health insurance coverage agreement announced today follows last week's unveiling of Governor Corzine's plan to prepare for any possible H1N1 influenza emergency and places New Jersey citizens ahead of nationwide emergency preparedness efforts. 

"This is welcome news," said Health Commissioner Heather Howard. "I would encourage all New Jersey residents - especially those at risk of serious complications from the flu - to protect themselves by getting vaccinated against H1N1 influenza when the vaccine becomes available later this fall." 

Anyone with questions or problems regarding H1N1 vaccine coverage under New Jersey plans should contact the Department at 1-800-446-7467 (SHOP), 609-292-7272 or at www.njdobi.org. 

For more information on H1N1 influenza in New Jersey visit the state's Web site at http://nj.gov/health/.To access federal information on H1N1 influenza go to www.flu.gov.                                                                       

 

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