H1N1 (swine flu)

 Aetna’s policy on H1N1 flu vaccine

• Aetna will cover administration of the H1N1 flu vaccine for all fully insured medical plan members and self-funded plan members unless the plan sponsor decides otherwise. We are offering this coverage even in instances where the member's plan does not include coverage for preventive care or has limits on such coverage.
• Co-pays, co-insurance and deductible will not apply for the administration of the vaccine. 
• CPT code 90470 or HCPCS code G9141 are the codes that may be used to submit claims for H1N1 vaccine administration.
• Since the H1N1 vaccine will be made available at no cost to providers, Aetna will not pay providers for the vaccine. Providers do not need to place 90663 or G9142 (H1N1 vaccine code) on the claim.
• Aetna will pay for the administration of one or two doses of H1N1 flu vaccine, based on recommendations from the Centers for Disease Control and Prevention (CDC).
• Aetna will pay for the seasonal flu shot and its administration on the same or different dates of service as the H1N1 flu vaccine for members enrolled in plans that include coverage for preventive care.

Information for pharmacies and mass vaccinators outside Aetna’s network
How to bill Aetna for administering the H1N1 flu vaccine 

Take our pandemic flu CME course
We invite physicians, nurse practitioners and office staff to take our “Pandemic Flu: Aware and Prepared CME” course. It is available at AetnaEducation.com, Aetna’s education site for health care professionals.

This one-hour course provides information and resources that will help your office prepare your patients and office staff for the flu – seasonal, avian and pandemic. CiNet Healthcare Learning designates this education activity for a maximum of one category 1 credit toward the AMA Physician’s Recognition Award for physicians and nurse practitioners. Credit is not available for office staff. 

Aetna's overall preparedness strategy
At Aetna, we have had a pandemic plan in place, and our team is working to make sure we are ready to meet the needs of our provider community and our members — your patients — should swine flu begin to spread rapidly.

Be assured that we are closely monitoring the recommendations of government organizations. If the Centers for Disease Control and Prevention or other federal agency makes recommendations on vaccinations or treatments for swine flu, we will adapt our coverage policies accordingly.

How Aetna stands ready to help
We have an extensive business continuity program in place that is designed to prepare us to react to a broad range of crises. Our pandemic readiness activities focus on eight areas. We are:

• Leveraging our business continuity strategies for contingency staffing to ensure we can serve our customers, members and providers
• Developing alternate operating models aligned with stages of a pandemic
• Determining which coverage policies would need to be modified in a pandemic and when to implement modifications 
• Implementing a workplace infection control program
• Monitoring situation reports from the World Health Organization, U.S. Centers for Disease Control and Prevention and other authoritative bodies so that we are ready to enact our plans as needed
• Collaborating with other leading organizations where appropriate to improve outcomes in the event of a pandemic
• Evaluating the pandemic readiness of our critical vendors and business partners
• Communicating with employees, members, plan sponsors, providers and other key constituents

Aetna's pandemic plans are consistent with the National Strategy for Pandemic Influenza developed by the federal government. We continually monitor our preparedness using a pandemic planning checklist designed specifically for health insurers, provided by the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention.

How you and your office staff can prepare
Aetna's Education Site for Health Care Professionals offers two courses at no charge: a CME for physicians entitled "Pandemic Flu: Aware and Prepared CME" and a non-credit course for office staff entitled "Pandemic Flu Awareness and Preparedness for Office Staff." These courses provide information and resources to help prepare for an outbreak of pandemic flu or similar health crisis.

The CME course can help physicians:

• Articulate the most appropriate practices for mitigating the impact of a flu outbreak
• Develop a strategy to prepare staff and patients for a potential pandemic flu outbreak
• Access resources to help determine an office's readiness for a pandemic flu outbreak

The non-credit course can help office staff:

• Differentiate the various types of influenzas
• Recognize four critical areas of focus for Infection Control
• Identify some of the steps Aetna has taken to prepare for a pandemic
• Create a personal contingency plan

How to enroll
To enroll, physicians and office staff can log in to the Education Site for Health Care Professionals (through our secure provider website via NaviNet®) and select "CME Courses" or "Office Staff Courses" (as appropriate) from the course catalog.

Helpful resources for you and your patients

• For comprehensive information on the potential for pandemic, including continually updated information on the swine flu situation, refer to the U.S. government's official pandemic website.
• There is also good information for your patients on the swine flu, Swine Flu and You, on the Centers for Disease Control and Prevention's website.
• Visit Aetna's website to view information available to our members. 
• Download, print and share these helpful "Health Tips"  with patients. 
• Read "Guidance for Professionals."