California PPO Insurance Plans

California Insurance Commissioner Steve Poizner said Wednesday that the state’s six largest health insurers regulated by the commissioner have agreed to take “extraordinary efforts” to make sure their enrollees can get the H1N1/swine flu vaccine by eliminating co-pays and deductible payments.

Poizner’s statement specifically mentions Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, HealthNet and United HealthCare/Pacificare. Kaiser Permanente’s Kaiser Foundation Health Plan, the state’s largest with about 6.6 million enrollees, is not covered by the agreement, which affects only PPO health plans that are regulated by the Department of Insurance, said DOI spokesman Darrel Ng.

Poizner said he joined officials of the Department of Managed Health Care and the California Department of Public Health in sending a letter to every health insurer in California, outlining statewide goals for administration of the soon-to-be released vaccine. Because this year's H1N1 flu strain appears to be more contagious than typical varieties of influenza, it is important that the appropriate risk groups be vaccinated, the commissioner’s statement said.

“To make sure that happens,” Poizner announced that all six of California’s largest PPO plans have agreed to waive co-pays and deductibles so enrollees can get vaccinated without spending any out-of-pocket funds.

“I am pleased that Aetna, Anthem/Blue Cross, Blue Shield, CIGNA, HealthNet and United HealthCare/Pacificare have agreed to put the health of consumers first by waiving costs for the H1N1 flu vaccine during what we anticipate to be a tremendously difficult flu season,” Poizner said. “Action taken by these insurers will help us prevent the spread of what is a potential flu epidemic. Now that the insurers are easing the way, I urge their members to take advantage and get immunized. Policyholders should pay special attention to communications from their insurer to understand exactly what they will need to do.”

HMO plans, like Kaiser's, are regulated by the Department of Managed Health Care. Many insurers offer both types of plans.

The federal Centers for Disease Control and Prevention has identified key target groups for vaccination as including pregnant women, people who live with or care for children younger than six months of age, health care and emergency medical services personnel, children and young adults between the ages of six months and 24 years old, and people between 25 and 64 years old who are at higher risk because of chronic health disorders or compromised immune systems.

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