Knowledge is power

While the recent emergence of novel influenza A (H1N1 or swine flu) has been widely reported, Horizon Blue Cross Blue Shield of New Jersey wants to ensure that you are up-to-date with information regarding the spread of this new virus.

The following information can help address misconceptions you may have about the severity of the virus and educate you about the best ways to protect yourself and others from the virus.

What is novel H1N1 (swine flu)?

Novel H1N1 (swine flu) is a new influenza virus that is spreading from human to human, leading the World Health Organization (WHO) to recently declare the spread of the virus a pandemic flu outbreak.  This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America.  But further study has shown that this new virus is very different from what normally circulates in North American pigs.

Because it’s a new virus, no one has immunity to it and everyone could be at risk of catching it.  This includes healthy adults as well as older individuals, children and those with existing medical conditions.

How does flu spread?

Flu viruses are made up of tiny particles that spread through the droplets from your nose and mouth when you cough or sneeze.  When you cough or sneeze without covering your nose and mouth, those droplets can spread, putting others at risk of breathing them in.

If you cough or sneeze into your hands, the germs are easily spread from your hands to any hard surfaces that you touch, and those germs can live on those surfaces for some time.  If other people touch those surfaces and then touch their eyes, nose or mouth, the germs can enter their systems and they can become infected.  That is how all cold and flu viruses are passed from person to person.

What are the symptoms of the flu?

Some common symptoms are:

• Fever
• Cough
• Headache
• Chills
• Sore Throat
• Sneezing
• Tiredness
• Loss of Appetite
• Aching Muscles
• Runny Nose

What have our federal and local governments been doing to prepare for a flu outbreak?

Our federal and local governments have been preparing for a flu outbreak for many years.  The Centers for Disease Control and Prevention (CDC) and WHO are monitoring the current situation, and there is good reason to be confident that the United States and the rest of the world will be able to provide a preventive vaccine and control a flu outbreak.  There is an ample supply of antiviral drugs (including Tamiflu^©´ and Relenza^©´´) – enough to treat millions of people.

While antiviral drugs are not a cure, if taken within 48 hours of developing symptoms, they help you recover by:

• Relieving some of your symptoms.
• Reducing the length of time you are ill.
• Reducing the potential for serious complications, such as pneumonia.   

Is there a vaccination?

As the novel H1N1 virus is a completely new type of virus, the U.S. government has been working closely with manufacturers to develop a novel H1N1 vaccine.

The novel H1N1 vaccine has been approved by the U.S. Food and Drug Administration (FDA) and will be available to physicians and other health care professionals shortly.  Seasonal influenza vaccinations are already available.  The CDC has stated that the H1N1 vaccine is not intended to replace the seasonal flu vaccine.  Seasonal flu and H1N1 vaccines may be administered on the same day, according to the CDC.

Will the H1N1 vaccine be covered by Horizon BCBSNJ, once available?

Once it’s available to the general public, the H1N1 vaccine will be distributed by the federal government.  Horizon BCBSNJ will cover the administration of the vaccine.

The decision to cover the H1N1 vaccine administration is based on formal recommendations released by the CDC's Advisory Committee on Immunization Practices.  ACIP recommended initial prioritization for those administering the vaccine for five key populations, including:

• Pregnant women.
• People who live with or care for children younger than 6 months of age.
• Health care and emergency services personnel.
• Children and young adults from 6 months old to 24 years old.
• People ages 25 through 64 years old if they have chronic medical conditions that increase their risk of  complications from influenza infection.

What can I do to protect myself and others from the flu?

The best thing you can do to protect yourself is to practice good hygiene.  Face masks won’t prevent you from being infected with the flu.  Practicing good hygiene helps slow the spread of the virus and is the single most effective precaution you can take to protect yourself and others from infection.  The rules of good hygiene include:

• Using clean tissues to cover your nose and mouth when you cough or sneeze, or coughing or sneezing into the bend in your arm.
• Discarding tissues after you use them.
• Washing your hands often with soap and hot water or using sanitizer gels.
• Calling your physician for guidance if you think you have symptoms of the flu.

How do I submit a claim for the administration of the H1N1 vaccination along with an Evaluation and Management (E&M) service?

When submitting a claim for the administration of the H1N1 vaccine on the same date of service as a scheduled, routine office visit, please include modifier 25 with the office visit.

Using Modifier 25 identifies that the E&M services are separately identifiable E&M service performed on the same day, to the same member, by the same physician as the other (H1N1 vaccination) service.

Where can I get more information?

Visit the following Web sites to get more information:

New Jersey State Department of Health and Human Services (NJSDHHS):
www.state.nj.us/health 

Centers for Disease Control and Prevention (CDC):
www.cdc.gov
www.pandemicflu.gov

World Health Organization (WHO):
www.who.int

Coverage of the H1N1 vaccine administration is for fully insured members. Many of our self-insured (ASO) groups are also providing coverage for H1N1 vaccine administration.  Members of self-insured groups should check with their benefits administration regarding their policy on H1N1 coverage.

©´ 2009 Roche Laboratories Inc.

©´´2009 GlaxoSmithKline.