Members and dependents who are not covered by Medicare can obtain their routine immunizations and vaccinations, in accordance with the current Centers for Disease Control and Prevention guidelines, at the pharmacy. In the past, these were available under the health plans only. The vaccine and the administration fee are also covered under the pharmacy benefits at 100 percent, if the services are provided by a network pharmacy.
Participants are subject to non-network benefits and can be balance billed for amounts above the allowable fees, when they use the services of a non-network pharmacy.
The existing immunization/vaccination benefits under the health plans remain the same.
Please note that under the health plans:
- Only network physicians/providers/pharmacists can provide these services.
- Mid-level practitioners such as physician assistants and nurse practitioners practicing at a free-standing ambulatory care clinic located at a pharmacy may or may not participate.
- NON-NETWORK PHARMACISTS ARE NOT RECOGNIZED AND ARE NOT COVERED.
Immunizations/vaccinations covered under pharmacy benefits when a network pharmacy is used:
Haemophilus Influenzae Type b
Measles, Mumps & Rubella
Rabies, Human Diploid
Rabies, PF Chick-EMB Cell
Tetanus, Diphtheria, Pertussis