Vaccinations, including the vaccine and its administration, are covered under both medical and pharmacy benefits.
CDC-recommended vaccinations, such as for shingles, are covered at 100% when using a network pharmacy. These can also be covered under the health benefit if provided by a recognized network health provider, such as a physician or health department.
Vaccine administration fees are also covered at 100% if the services are provided by a network provider.
When using a non-network provider, members and dependents are subject to non-network benefits and can be balance billed for amounts above the allowable fees
- Only network physicians or network providers can provide these services under the medical benefit.
- Mid-level practitioners such as physician assistants and nurse practitioners practicing at a freestanding ambulatory care clinic located at a pharmacy may not be network.
- Non-network pharmacists are not recognized and are not covered under the medical benefit.
Covered vaccinations include:
- Haemophilus Influenzae.
- Hepatitis A.
- Hepatitis B.
- Human Papillomavirus.
- Influenza A.
- Influenza HD.
- Japanese Encephalitis.
- Rabies, Human Diploid.
- Rabies, PF Chick-EMB Cell.
- Shingrix (Shingles).
- Smallpox (Vaccinia) Vaccine.
- Tetanus Booster.
- Tetanus, Diphtheria, Pertussis.
- Yellow Fever.
- Zoster (Shingles).
This list is not all-inclusive.