Our Pandemic Preparations: Policy modifications

Determining which coverage policies would need to be modified in a pandemic and when to implement modifications:

• In a severe pandemic, our members may need to seek care in alternative settings. Aetna is prepared to make policy or procedural modifications as necessary both to our internal operations and to our coverage policies based on clinical considerations as well as direction from state and federal authorities and plan sponsors. We already have extensive experience in meeting our members' needs during the H1N1 pandemic. For example, we put processes in place during the pandemic to cover vaccines administered in pharmacies or other non-medical provider settings. We also have experience with large-scale crises that have affected the delivery of health care in recent years, such as hurricanes on the Gulf Coast, wildfires in California and flooding in the Mid-West. Our well-established mechanisms in place evaluate local and regional situations and rapidly implement coverage policy modifications as needed.
  
  
• During these natural disasters and the H1N1 pandemic, we modified our coverage policies with the support of plan sponsors to help members access the care they needed in a difficult situation. During the H1N1 pandemic, for example, we modified our policy to cover H1N1 vaccines at no cost for all fully insured medical plan members, and all members of self-funded plans unless directed otherwise by the plan sponsor. Depending on the circumstances of pandemic, we may make pharmacy modifications such as encouraging early prescription refills and waiving precertification or step-therapy requirements. Among modifications for medical plans, we may approve requests for out-of-network services and lift requirements for medical precertification, referrals and notification of hospital admission. We can also help members find alternative providers if their regular physicians are not available, and assist those providers with access to personal health claim records for the members they treat.