Nevada Earthquake Insurance Consumer Guide

On the 25th of February, the State of Nevada Department of Insurance released their “Earthquake Insurance – Nevada Consumer’s Guide“

After Alaska and California – Nevada comes in third in the country for major earthquakes – major earthquakes are 5.0 and higher in magnitude. Experience and seismic analysis suggest that no area of Nevada is completely safe from earthquakes.

Because of this, it is important for all Nevadans (including businesses) to be properly prepared for an earthquake.

Commercial and homeowner’ policies do not cover damages resulting from earthquakes or movement of the earth, unless endorsed to the policy or purchased separately.  The decision to obtain earthquake insurance for personal or commercial property should be based on understanding and tolerance of the risks associated by not having earthquake protection.

Educate yourself by reading the Earthquake Insurance – Nevada Consumer’s Guide.

Seeing how much Earthquake Insurance costs, can be is simple as asking our experts to assist you.

ARRA COBRA Premium Subsidy Update ***Updated March 3rd, 2010***

In our continuing effort to keep  you informed, Capstone is staying abreast of regulatory developments as they pertain to benefits related Department of Labor issues.

We wanted to bring you up to date on the latest developments regarding the original ARRA rules and premium Subsidy…

Last week’s efforts to extend the COBRA subsidy were NOT successful.  The current subsidy did not get extended and, thus, officially expired as of 2/28/2010.

What does this mean?  It means, that if, you had an employee that was terminated between September 1st, 2008 and February 28th 2010 they may be eligible for a 65% COBRA Premium subsidy for up to 15 months.

Congress is continuing to work to extend the subsidy.  The below current bills that are under consideration are:

• A House extension bill (H.R. 4691) – passed by the House last week and sent to the Senate – would extend the subsidy for one month, through 3/31/2010, and would provide a subsidy to individuals who experience an industry termination following a reduction in hours.
• A draft Senate Jobs bill – would extend the subsidy through 12/31/2010.  As it stands today it also includes language providing the subsidy to individuals who experience an involuntary termination following a reduction in hours.

If you have any questions/concerns regarding your company obligation surrounding the American Recovery and Reinvestment Act and the COBRA premium subsidy – please feel free to contact us by sending an email to info@Capstone1.com or calling (702) 227-5727.

We will continue to keep you up to date as more information becomes available.

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ARRA COBRA Subsidy Premium Extension

Yesterday, the President signed the Fiscal Year 2010 Defense Appropriations Act – this act extends the eligibility period for the COBRA Premium Reduction for an additional two months (through Feb 28, 2010) and the maximum period for receiving the subsidy for an additional six months (from nine to 15 months). 

Click here for the DOL Press Release

In other words – those  individuals who’s 65% premium subsidy was ending on December 31st, 2009 – will now be eligible for the premium subsidy through June 30th, 2010.

In addition – the December 31st 2009 eligibility deadline has been extended through February 28th, 2010.  A terminated employee is now eligible for the premium subsidy if his/her termination occurs before the end of February 2010.

The new COBRA ARRA provisions do the following:

• Change the end date of eligibility for the COBRA ARRA subsidy from December 31, 2009 to February 28, 2010 (a two-month extension);
• Expand the ARRA premium subsidy to 15 months (an increase from the nine-month period under the original provisions);
• Allow for a 60-day period for the retroactive payment of premiums for assistance eligible individuals (“AEIs”) (i.e., individuals who were entitled to the subsidy) whose subsidy period expired on November 30th and who failed to pay their premium for December coverage. The period will commence the day the provision is signed into law by the president, or, if later, 30 days after provision of the special notice (described below). The same refund/credit rules under the original bill will apply to any assistance eligible individual (“AEI”) whose subsidy expired in November and who has since paid the full COBRA premium;
• Require a special notice describing the new subsidy provisions to all AEIs who are on COBRA on or after November 1, 2009 or whose qualifying event is an “involuntary termination” of employment occurring on or after November 1, 2009
• Conditions eligibility for the COBRA subsidy on only one factor: a qualifying event that is an “involuntary termination” of employment occurring on or before the new February 28, 2010 sunset date. The previous version of the subsidy also took into account when the COBRA coverage period actually began. This means that employees who are involuntarily terminated before February 28, 2010 but still receive coverage subsidized by employers that defers the COBRA start date to a date later than February 28, 2010 will still be able to receive the subsidy.

Subscribe to our Blog for updates to this and other insurance related issues

Nevada Medical Liability Insurance

Nevada Medical Liability Insurance

A lot has happened since Nevada made national news when the only trauma

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center in Las Vegas (University Medical Center [UMC] of Southern Nevada) closed July 3^rd-13^th, 2002 due to general surgeons, trauma surgeons and orthopedic trauma surgeons being unavailable.  Skyrocketing medical liability insurance rates put an abrupt halt to their work at the trauma center.  This was caused by increasing jury awards and an excessive amount of filed malpractice claims.

The Nevada Attorney General issued an opinion allowing the surgeons who resigned to be covered by the state’s sovereign immunity cap as long as they signed new contracts with the UMC Trauma Center.  UMC was then able to enter into 45-day contracts with the surgeons, allowing them to reopen the center while the governor called a special session of the Nevada legislature.

On August 3^rd, 2002 the legislature passed a tort reform bill that included the following provisions:

• The statute of limitations was shortened from 4 to 3 years.
• Noneconomic damages for emergency services were capped at $50,000.
• Noneconomic damages were generally capped at $350,000 for each defendant, but there were exceptions.
• The medical/dental screening panel was eliminated
• Medical expert witnesses were required to practice in the same field as the defendant case.
• An affidavit was required to be filed for a case to proceed.

Because the reform allowed for exceptions, medical malpractice insurance premiums continued to rise.

Then in 2004, the Keep Our Doctors in Nevada (KODIN) imitative was created in order to create reform similar to what was enacted in California.  The Nevada ballot in 2004 included a question that provided the following:

• $350,000 “Hard Cap” on noneconomic damages per injury with zero exceptions
• Eliminated joint and several liability
• Placed limits on attorney fees
• Permitted either the plaintiff or the defendant to request periodic payments

The question was passed by a 60 percent majority.

Fast Forward to October of 2009

First and foremost medical liability insurance premiums have dropped by 25-45 percent, and because of the reforms, Nevada is no longer seen as one of the “problem states”.    According to the Nevada Department of Insurance there were six major insurers providing professional liability insurance for physicians and surgeons in 2004 – as of October 2008 there are eight authorized carriers.

In addition to the lower malpractice insurance premiums the net gains in Clark County physicians has continued and stabilized.  In 2002 there were just seven new licensees, and in 2003 just the promise of tort reforms brought a net gain of 212 licensees.  It’s interesting how a few simple changes can create such a positive outcome.

You the Physician

While purchasing insurance may not be your favorite pastime and specifically speaking malpractice insurance programs can be very mundane, but real bargains are available to those who use a firm that specializes in professional liability insurance programs.

All malpractice programs are not the same.  In fact, insurance carriers attempt to differentiate themselves with various added features.  Understanding the differences between programs is key, and your insurance broker should be able to explain these differences in simple terms.  Two things to keep in mind when purchasing Nevada malpractice insurance are:

1)    Attempt to purchase your policy from carriers with an A- rating or better.  Financial stability is extremely important and you should steer away from insurance carriers that have low ratings or not rated.

2)    Attempt to purchase your policy from a brokerage with a track record in the marketplace.  Certain firms have access to multiple carriers and can provide you with a true comparison of the available programs and prices.

Knowing the difference between the backbone of a malpractice policy and the added features is critical to purchasing a program that fits your particular needs.   Every physician specialty has different needs; therefore every medical liability carrier doesn’t work for every physician.  The added features may influence your purchase decision, but

never at expense of the backbone. While the backbone of most malpractice policies should be the same, there is a surprising amount of variation.

You need to be concerned with specific exclusions and limitations which directly affect your professional practices.  The following details some exclusions and limitations you need to be aware of (contact your brokerage for a full list):

• Hours of Practice
• Type of Services Rendered
• Location of Activities
• Limitations on Defense Costs and where the defense costs coverage lies within the policy
• Check to see if your policy has any sub-limits.

When reviewing the policies, “added features” may influence your purchase decision.  The real key is to determine which features actually bring value to you and your practice.  The following details some “added features” you may come across when purchasing malpractice insurance:

• Premise Liability
• Licensing Board Coverage
• Legal Bonds/Lost Income
• Premium Discounts and Premium Credits
• Severability of Limits

Types of Nevada Malpractice Insurance

Claims Made Coverage

In order to simplify things, you really only need to understand three features of claims made coverage:  the “tail”, the “nose” and step rates.

The Tail – by definition, “claims made insurance” means you have to buy coverage for a given policy period.  If you have a claim – you have to meet two tests:

1)    The alleged action must occur during the policy period. And…

2)    The policy must be in-force at the time the claim was filed

Claims made policies include an “escape clause”, so in order to protect you for an extended reporting period a “tail” must be purchased.  A “tail” allows you to stop renewing the claims made policy, and provides for future coverage of claims that occurred during the policy period.  Your insurance broker should be able to explain the difference between the two types of available tails.

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The Nose – Is the opposite of the “tail”.  Rather than purchasing a “tail” from your old malpractice carrier, your new carrier will cover you retroactively to the date you started your old claims made policy.  In general “noses” are less expensive than “tails” and depending on your specific situation your insurance broker should compare the differences for you.

Step Rates – “Noses” are nearly always less expensive than tails because of “step rates”.  When purchasing claims made professional liability programs, ask your broker for the step rates for each year – through maturity.  All admitted carriers must file these “step rates” with the department of insurance.  It is imperative that your broker provide you with complete “step rates”.

Occurrence Coverage vs. Claims Made Coverage

An occurrence policy with low value coverage features is not going to properly compare to a claims made policy with an unlimited tail.  When comparing the two, it is extremely important to compare programs on an apple to apples basis.  This rule never changes, the value of the policy is going to depend on the coverage it purchases – in other words – you still only get what you pay for!

A true occurrence product means you are insured for covered actions during that policy period – forever.  You purchase it once, and you are covered forever!  When purchasing and comparing these types of malpractice insurance products, your broker should be able to effectively compare several scenarios so that you can determine which program fits your specific needs.

Shopping for a Group Practice

Is your practice informally or formally organized?  Some informally organized practices may have restrictions built into the coverage because of the potential of “increased risk” of vicarious liability claims.  A formally organized group practice is one that is legally established as a partnership or corporation.  Solo practitioners incorporated as a Professional Association or a Professional Corporation that have no employees are normally treated as an “individual insured”.

Customer Advocacy

In some cases, service seems to get lost in the mix of price vs. coverage vs.

features.  These things are important, but don’t forget to take into account the customer service of the brokerage you are working with.  When discussing options and programs can the firm discuss the key features of the insurance policy and carrier, including the strengths

and weaknesses?  What is their history with the carriers they are representing

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you to?  Keep in mind, it is the brokerages job to package you, and your practice and present to the various carriers in the most favorable way.  Does the brokerage have your best interest in mind?  How do your insurance broker’s corporate values compliment yours?

Bottom Line

A solid insurance firm will review your medical malpractice insurance regularly.  They will bring you competitive options and introduce insurance companies new to the Nevada marketplace.  Partner with a specialist in the medical malpractice insurance market who can deliver consistent savings and value to your practice.

Health Plan of Nevada and the H1N1 Swine Flu Vaccine Coverage Information

H1N1 Swine Flu Vaccine Coverage Informatin

Below details the information that has been recieved from Health Plan of Nevada and Seirra Health and Life as of 10.15.2009.  If more information becomes available we will update this post.

Can you tell me about the swine flu vaccine?

 
The swine flu vaccine is available in both injectable (inactive virus) and nasal inhaler (active/live virus) form. In Nevada, shipments of nasal inhaler (FluMist) and injectable doses have been received by the Southern Nevada Health District (SNHD), and Washoe County Health District (WCHD). This will be followed by weekly doses of both nasal inhaler and injectible forms.

According to the CDC, additional doses of the vaccine will be shipped to state health divisions, local health authorities, and health care providers on a weekly basis. It is expected that although there will be limited doses available initially, the supply is expected to grow over the coming months and will eventually be sufficient enough to accommodate everyone who wants to receive the vaccine.

Can I get the swine flu vaccine in October? Or do I have to wait until later?

The Centers for Disease Control and Prevention (CDC) considers the following

Sierra Health and Life H1N1 Swine Flu Vaccine Coverage Information

 people as high priority for getting the vaccine as soon as it becomes available:

• Pregnant women
• Caregivers for children younger than 6 months of age
• Healthcare workers and emergency medical services personnel
• People from 6 months through 24 years of age
• Persons age 25 through 64 who have underlying health conditions that might produce complications from a flu – including asthma, diabetes, heart disease and kidney disease

If you are unsure whether you should receive the vaccine, ask your doctor or call the Health Plan of Nevada / Sierra Health and Life 24-hour Telephone Advice Nurse at 702-242-7330 or 1-800-288-2264.

Where can I get the vaccine?

In Southern Nevada:
The Southern Nevada Health District is offering the FluMist inhaled vaccine, Monday through Friday, October 12-16, from 10 a.m. to 6 p.m., at the health district’s main public health center at 625 Shadow Lane.

The CDC recommends the inhaled vaccine for healthy people between the ages of 2 and 49. It is also recommended for health care workers and EMTs.

The first clinic that will offer injectable vaccine as well as the inhalable FluMist is scheduled between 10 a.m. and 6 p.m. on Saturday, October Priority groups eligible to receive the vaccine at this time include:

• Pregnant women
• People who live with or care for children younger than 6 months of age
• Health care and emergency medical services personnel with direct patient contact
• Children 6 months through 4 years of age
• Children 5 through 18 years of age who have chronic medical conditions

In Northern Nevada:
For information on vaccine availability in Washoe County, please call WCHD at 1-866-767-5038.

Outside of Nevada:
Please contact the Public Health Clinic in your area or your health care provider’s office for information on vaccine availability.

Will I have to pay for the swine flu vaccine?

No, you will not have to pay for the swine flu vaccine. UnitedHealthcare / Health Plan of Nevada / Sierra Health & Life will cover the administration fees, regardless of where you receive the vaccine

If I get sick, will my prescription treatments be covered?

Antiviral therapy is an important part of the prevention and treatment of swine flu. If you get sick and your doctor recommends treatment, you will be covered in accordance with the prescription drug component of your plan coverage. Currently, the recommended treatments are Tamiflu and Relenza.

Aetna to Cover Administration Cost of H1N1 Swine Flu Vaccine for all Medical Members

Aetna Swine Flu H1N1 Coverage Information

Aetna has made the decision to cover administration of the H1N1 flu vaccine for all fully insured medical plan members and all members of self-funded plans unless directed otherwise by the plan sponsor. Aetna will provide this coverage even in instances where members’ specific health plans do not provide coverage for preventive care or have limits on such coverage. Aetna will cover the full cost cost of the administration of the vaccine with no member copay, co-insurance or deductible applied.

A press release announcing this decision

We are also directing self-funded plan sponsors who do not wish to cover the full cost of administration of the H1N1 vaccine to notify us by October 5, 2009.

Communicating with their members
Aetna is  reaching out to all members in many ways. Educational mailings to members have begun, and messages will be included in the Member Essentials e.newsletter. In addition, professionals staffing Aetna’s member services call centers have received special materials on the H1N1 flu so they are well prepared to answer questions.

Aetna will also use information available in our CareEngine® to proactively identify members who fall into three of the five categories of “priority individuals” as defined by the Centers for Disease Control and Prevention (CDC). Aetna will reach out to these members and urge them to be vaccinated.

These three categories are:

1. Members who are younger than 65 years of age who have health conditions associated with higher risk of medical complications from influenza
2. Persons 6 months to 24 years of age
3. Pregnant women

Members in these high-risk groups will receive Care Considerations sent to their personal health records with information on H1N1 flu, their specific risk factors and suggestions they consider vaccination. Aetna will include information about all of the priority groups, including those Aetna cannot readily identify through their records – health care workers/emergency personnel and caregivers of children six months and younger – in messages sent to all members’ Aetna Personal Health Records.

Additional preparations and resources
In a similar effort to reach high-risk members, Aetna is providing H1N1 training to nurse case managers who work with members enrolled in Aetna’s disease management, case management, and Beginning Right® maternity programs. Members in these programs may also be among those the CDC has targeted for prioritization when the vaccine is first available.

Resources available to all members on Aetna’s public website include fact sheets and Question & Answer documents, with up-to-date information on the H1N1 flu along with tips on preventing infection. Aetna has posters and flyers for download with tips on how to avoid the flu. Aetna also has a video that discusses proper hand washing technique and worksite hygiene.

Aetna will continue to update pages on aetna.com for members and plan sponsors.

Aetna’s commitment to help
Aetna is committed to doing their part to decrease barriers to vaccination and minimize the administrative complexity of providing access and financing for the administration of this vaccine. As Secretary of Health and Human Services Kathleen Sebelius said in a letter to health plans, “It is in everyone’s interests to help reduce the demand for and costs associated with emergency room use and in-patient hospitalizations and to minimize disruption in the workforce’s productivity by having as many people as possible vaccinated… Together, all of us doing our part will ensure that we minimize the consequences of the H1N1 virus on our citizens, businesses, and the economy.”

For more information and resources, visit www.aetna.com and select “H1N1 and Seasonal Flu” or contact your Aetna representative.

H1N1 Vaccine – UnitedHealthcare Actions

United Healthcare of Nevada

UnitedHealthcare, working in concert with public health authorities, providers and others, is taking a number of steps to reduce or eliminate barriers to H1N1 immunization. They are also developing educational materials based upon guidance from the Centers for Disease Control and Prevention (CDC) to help enrollees stay informed.

Coverage for the Vaccine
UnitedHealthcare will cover the administration of the H1N1 vaccine for all fully insured members, with no copays, deductibles or coinsurance fees. For self-funded clients, including those that exclude immunization coverage, they intend to process all H1N1 vaccine administration claims as a covered service, with no copays, deductibles or coinsurance fees, unless directed otherwise by the client by Oct. 12, 2009. Based on direction from the CDC, we will be paying the physicians based on Medicare approved rates (based on MSA) or billed charges, whichever is lower.

For Health Maintenance Organization (HMO) clients, please instruct your members to consult with their primary physicians to receive the H1N1 vaccine.

Vaccine Distribution and Availability
The H1N1 flu vaccine is being distributed to each state by the federal government. Every state is developing a vaccine delivery plan, which will likely include a combination of physician offices and non-traditional settings. UHC has worked diligently with a number of partners to ensure that UnitedHealthcare members have a broad range of options from which to select to get the H1N1 flu vaccine:

• Public Health Clinics: Members may be able to receive their H1N1 vaccine at most local public health clinics at no cost or at a federally subsided rate.
• Doctor’s Office: The cost of the vaccine, needles, syringes, alcohol swabs and sharps containers will be fully paid for by the U.S. government.  UHC will cover the administration of the H1N1 vaccine for all fully insured members, with no copays, deductibles or coinsurance fees. For self-funded clients, we intend to process all H1N1 vaccine administration claims as a covered service, with no copays, deductible and coinsurance fees, unless directed otherwise. HMO members should consult with their primary physician to receive the H1N1 vaccine.
• Retail Pharmacies: Members will be able to have the H1N1 vaccine administered at several major retail pharmacy chains. There’s no up-front cost to the member, if they choose this option. Participating pharmacies will submit a nominal fee to us for administering the vaccine. UHC will fully cover this fee for all insured members and debit self-funded client accounts accordingly.

A list of public health clinics and participating pharmacies will be posted on UnitedHealthcare.com and myuhc.com, starting later this week and will be updated regularly. Members should be encouraged to call to ensure that the pharmacy has the vaccine and is participating in the UnitedHealthcare program.

Priority Populations
The CDC has prioritized the following high risk population segments to initially receive the vaccine, with others to follow as the vaccine becomes more widely available:

• 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.

H1N1 Member Materials and Support
UHC is taking action to assist all UnitedHealthcare members, especially those identified by the CDC as being at a greater risk for complications from the H1N1 flu. An employee communication template outlining a variety of member resources, including links to our dedicated H1N1 information section on our Web site, Frequently Asked Questions, an audio webinar on H1N1 and more is included. UHC is strongly encouraging you to customize and share this communication with your employees.

In addition they are taking the following actions:

• Targeted Outreach to High Risk Populations: Working closely with our care management team, we are launching a targeted campaign to reach out to members in populations prioritized for immunization identified by the CDC, such as pregnant women and those with underlying health conditions.
• NurseLineSM: Their Care24® NurseLine and Maternity NurseLine (offered through the Healthy Pregnancy Program and the Maternity Support Program) clinicians have been fully trained to address questions related to H1N1 flu, especially how it relates to pregnant women, children and other at-risk populations. These services are available for those who have these benefits.
• Customer Care: Their customer care professionals are ready to assist members and can be reached at the toll-free number on the back of their member ID card.

Business Continuation Preparedness
United Healthcare wants to reassure clients that if this situation escalates, they are fully prepared to initiate our business continuation program, which is designed to minimize any type of service disruption.

For More Information
Enclosed is a list of frequently asked questions, with additional details on their actions. For the most up-to-date clinical guidance, please visit www.cdc.gov/h1n1flu.

You may also contact us for questions specific to your United Healthcare Group  Policy.

Anthem Blue Cross Important H1N1 Vaccination Coverage Information

Anthem Blue Cross and Blue Shield of Nevada

According to Anthem Blue Cross, the U.S. Food and Drug Administration has approved and obtained a vaccine to combat the H1N1 virus (also know as the “Swine Flu”), and it’s expected to be available later this month. The following provides you with details on expanded benefits coverage (from Anthem Blue Cross) for the vaccine and related medications, as well as important information pertaining to self-insured, Administrative-Services Only (ASO) clients.

Coverage Details

For Anthem Blue Cross members, the following changes to pharmacy benefit coverage related to the H1N1 virus have been enacted:

• Waived member deductibles, coinsurance, and co-pays. First-dollar coverage for the administration of the H1N1 vaccine by contracted providers to fully-insured members, regardless of current vaccination benefit. Providers are expected to accept insurance payment in full so that no out-of-pocket costs will be incurred by members.
• Expanded H1N1 coverage benefit for ASO clients. All ASO claims will adhere to the first-dollar coverage benefit by default, and any client opt-out will be treated as an exception. ASO clients will have the opportunity to opt-out of first-dollar coverage; sales representatives will need to distribute a H1N1 Vaccination Coverage Opt-Out Form to ASO clients, and clients will have 30 days to return the form to opt-out of providing expanded coverage to members. The H1N1 Vaccination Coverage Opt-Out Form will be distributed to impacted clients over the next several weeks.

Anthem recommends ASO clients strongly consider the financial implications of opting out of the expanded vaccination coverage benefit for their members. The H1N1 administration fee is typically $15 or less. Vaccination is the best protection against contracting the H1N1 flu, which can lead to absenteeism and increased health care utilization, including costly hospitalizations. The U.S. health care system has a responsibility to achieve maximum vaccination coverage and effective treatment of H1N1 flu risks. In light of these considerations, we are eager to do our part to ensure that our members are immunized against this virus.

• Vaccine availability.  The U.S. government has purchased 200 million doses of H1N1 vaccine and will make the vaccine available this month, both as a nasal spray route of administration and traditional needle vaccination. The U.S. Department of Health and Human Services (HHS) will be distributing the vaccine to state health departments, and it is anticipated that a significant proportion of the H1N1 vaccine will be administered through non-traditional providers such as pharmacies, retail clinics, schools, universities, and public health clinics. Our network management team is working closely with NextRx to complete contracting agreements with retail pharmacies and immunization vendors to increase access to the H1N1 vaccine. The H1N1 vaccine is expected to be released in mid-October.
• Minimizing member cost for treatment. For members who require the antiviral medications Relenza and Tamiflu for the treatment of the H1N1 virus, benefit coverage will be increased. These medications will be covered as Tier 2 formulary for all members with pharmacy benefits.

Future Communications

Anthem Blue Cross Employer Groups will be notified of benefit changes related to H1N1 in the fall issue of the MyAnthem News  employer newsletter, which will be distributed to small and large employer groups on Friday. Members will be able to visit the health plan web site for information on expanded vaccination benefits.

Additional details will be communicated by Anthem Blue Cross as soon as they become available.

For More Information

For information on the expanded vaccination benefit and how our health plan is responding to H1N1, refer to the Frequently Asked Questions.

For more information on the H1N1 virus, including vaccine availability, visit www.flu.gov. You may also review What You Need To Know About H1N1 Flu Prevention for information about the H1N1 virus.

For questions related to benefit coverage levels and access, contact us.

Anthem Blue Cross Flu Shot Options for Nevada Group Members

Anthem Blue Cross and Blue Shield of Nevada

Flu shots available at local pharmacies through Anthem NextRx: For members not on a Lumenos health plan, flu shots can be obtained at many local chain pharmacies. The vaccine will be administered by a pharmacist with a copay of $10. Simply present your Anthem insurance card at the pharmacy just as you do when filling a prescription. Not all pharmacies may offer this program or may require that appointments be made.

Major chains offering flu shots are K-Mart, King Soopers, City Market, Safeway, Save-On (Albertsons), and Walgreens. Please check with your pharmacy or visit their website to see their requirements. You may also contact the customer service department at the phone number on your ID card to inquire about participating pharmacies.

Flu shots available through your In Network Provider’s Office:
Flu shots may be available under your benefit plan through your In network provider. An office visit copay or coinsurance and deductible may apply so check please check your certificate of coverage for benefit information or call customer service at the number on your ID card.

Flu Shot Clinic Benefit:
For members of employers with 51 or more employees, and members of new and renewing employers with 2-50 employees as of 10/1/2009, you may be eligible for reimbursements for flu shots received at flu shot clinics. The annual maximum reimbursement amount allowed is $25.00 and is subject to change. To use this benefit, please print a copy of the Flu Shot Clinic Form and submit a signed copy with a receipt and/or a copy of the consent form with the amount paid to the address on the claim form. Flu shots received from your in-network doctor’s office are not eligible for reimbursement and you will pay the corresponding office visit copayment, deductible, and/or coinsurance for your plan.

• Examples of locations offering retail flu shot clinics may include your local grocery, Walmart, Walgreens etc…
• A flu shot that is otherwise paid for, in part or full, by another party is not covered.
• To determine if you are eligible for this benefit, please check your certificate of coverage.

Employee Benefits and the Economy

“In the midst of a recession that has been called the worst since the Great Depression, workers prize employee benefit plans more than ever. In times like these, access to good benefits means employees can take care of themselves and their families, regardless of what is going on in the economy. At a time when employers may be looking to reduce costs any way they can, it’s important to understand the long-term effects of cutting back on benefits. A short-sighted decision now may have unanticipated effects down the road when companies are once again counting on loyal employees to help them maintain that “edge” in a competitive marketplace.”

Impact of the Downturn

The economic downturn has had a broad impact on both employers and employees. Two-thirds of respondents to a Guardian survey reported, for example, that their employers have taken some action in response to the economic downturn. Tactics include training employees to do more than one job (47%), employee layoffs (33%), requiring longer hours or more work (26%), and instating furloughs and unpaid time off (16%).

Meanwhile, the economy is influencing behavior and lifestyle decisions on the part of employees with regard to benefits. One-quarter of employed consumers are afraid to take time off for illness, vacation, or leave of absence. On the West Coast, where unemployment is particularly high, this figure jumps to one-third.

Employees say they’re afraid to take vacation time (18%) and are not taking or cutting short leaves for medical or other reasons (16%). Some are returning early from maternity leave or other leave of absence (11%), while others who are pregnant or ill are afraid to take time off (10%). Some even say they’re postponing a divorce to preserve benefits (8%) or accelerating a marriage to obtain benefits coverage (6%). Consumers in the West are more likely to consider the impact on benefits when taking time off, while those in the Northeast are more likely to accelerate a marriage or delay a divorce.

The true cost of health coverage remains a source of misunderstanding for many employees. Fully 71% either significantly underestimate or don’t know the cost of individual health coverage in comparison to group coverage. What’s more, nearly one-third of workers think it is more expensive to obtain healthcare coverage at work than it is to buy coverage on their own.”

To see the importance of benefits to consumers and full statistics of the survey click here.