Employers & Organizations: Preparing for the impact of a pandemic FAQs

How does Aetna ensure that its different functional areas and individual employees are prepared to implement a business continuity plan if needed? 
We have continuity strategies for each operational area of the company, developed in coordination with our overall contingency planning initiatives. We hold crisis simulations several times a year and have held at least one simulation at each of our locations nationwide. Each simulation exercise involved an avian flu outbreak at one or more of our critical operations. 

Will Aetna order H1N1 or seasonal flu vaccine for distribution?
We have no plans to do so at the present time. The federal government is distributing H1N1 vaccines to the states, which in turn will distribute them to registered vaccinators in each state. Seasonal flu vaccine is readily available for use by Americans in the coming flu season.

We encourage our members to get vaccinated for both H1N1 and seasonal flu as clinically indicated, and we encourage older members to consider an anti-pneumonia vaccination as well.

In light of the pandemic, will Aetna stockpile antiviral medications (Tamiflu and/or Relenza) for distribution? 
Aetna will not stockpile these drugs. The Department of Health and Human Services (HHS) has stockpiles of antivirals and allocates them to states based on population. CDC’s Division of the Strategic National Stockpile (SNS) manages the release of its antiviral drugs, personal protective equipment, and respiratory protection devices to help states respond to the outbreak as needed. At the present time, no shortages of antiviral medication are anticipated. 

Would Aetna cover prescriptions for Tamiflu or other meds in advance of a diagnosis? 
Aetna plans that include a pharmacy benefit covering brand-name drugs will cover physician prescriptions for Tamiflu and/or Relenza for treatment of a diagnosis, or as a preventive measure as prescribed by a physician. Member co-payments or co-insurance are applied as noted in the member's benefit plan. 

Where will vaccines be available?
State and local public health departments will designate which public and private sites will be given the vaccine. Public sites could include public health clinics and clinics located in schools. Private sites could include provider offices, workplaces or retail settings. Aetna is encouraging participating providers to register with their state’s Department of Health to become vaccinators.

A number of retail sites, including Minute Clinics/CVS, Take Care Health, and RediClinics, also are expected to be vaccinators. We will encourage our members to seek vaccines at any of these available outlets (note that emergency rooms are not the appropriate place to seek vaccines). 

How can employers help their employees receive H1N1 vaccines?
Employers can hire a commercial designated vaccinator that will provide the vaccine on-site. We expect that at least some of the corporate seasonal flu shot vendors used by Aetna will be able to offer H1N1 vaccines at employer worksites, but this may vary by state. We can share more information on this once the vendors are able to register and be designated as vaccinators by the states.

Employers also can seek to be designated by their state or local public health department as vaccinators and have vaccine shipped to them. If you wish to pursue this approach, you would need to reach out to the appropriate state departments of health for information.

Does Aetna have any restrictions on Tamiflu and Relenza? Is there any protection against people "stockpiling" the medication, leading to shortages for people who need it?
Tamiflu and Relenza are available to the Aetna membership without precertification up to two treatments per calendar year. Anti-influenza drugs are covered for both treatment and prophylaxis as prescribed by physicians. We do have a quantity limit program that allows two treatments per year; this program is standardly included on our fully-insured book of business and available to our self-insured plan sponsors. Members can go through the precert unit to get an additional prescription authorized. Up to this time, we have had no such requests. We will continually monitor the situation and will adjust our quantity limits in accordance with CDC treatment recommendations. 

Will Aetna cover claims related to the H1N1 virus under all of its products – medical, disability, AD&D and life?
H1N1 virus will be treated as any other disease under all of our plans. However, flu-related illness is not generally considered an accidental injury under an AD&D plan.

Will an H1N1 vaccine be available? Will Aetna cover it?
Aetna will cover H1N1 flu vaccine administration for members whose benefit plan covers preventive services, just as we have covered the seasonal flu vaccine. We will pay for the administration of one or two doses of the H1N1 vaccine, based on recommendations of the Centers for Disease Control and Prevention (CDC).

The federal government will pay for the H1N1 vaccines and the supplies needed to administer them. Aetna will reimburse providers for administration of the vaccine.

If a member goes to an emergency room with flu symptoms, will Aetna consider this an emergency situation and reimburse accordingly?
It is expected that most people will recover from H1N1 flu without needing medical care. If members have severe illness or are at high risk for flu complications, they should contact their health care provider or seek medical care. Members with fever and other flu symptoms, upon medical record review, may be considered appropriate for an emergency room visit. Most of the time, H1N1 flu is not serious and members can be cared for at home. 

What if an employee becomes ill while traveling on business outside of the country?
The coverage available to your employee is based on your medical plan. In general, domestic plan members can access medical care abroad, including treatment by a physician and coverage for prescription medications. If the employer has purchased Aetna’s Informed Health Line or Enhanced Member Outreach, nurse consultations by phone would be available.

How does Aetna plan to maintain its data centers if the pandemic begins to impact employees significantly?
We have conducted a rigorous analysis of the potential impact of a pandemic on our data centers. The high degree of automation in these centers, coupled with our technical capability to operate these centers from a remote location, minimizes the potential risk to maintaining operations in the event of a localized outbreak. Our current contingency plans should permit us to maintain operations in these centers even with a 60% to 70% absenteeism rate, substantially above most predictions for a severe pandemic. We have also taken specific actions to implement stringent infection-control procedures in these centers, and are developing "self-sufficiency" procedures for these sites in the event of quarantine.

Has Aetna communicated to its employee base (regionally and/or globally) its preparations for a pandemic outbreak?
Yes.

Can Aetna share more information on its business continuity program with plan sponsors?
Yes. Your Aetna representative can obtain a description of the program to share with you along with our assessment on the business pandemic planning checklist for health insurers provided by the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention.