This year, access to the seasonal influenza and H1N1 (Swine flu) vaccine are limited due to a deficit in vaccine supply and, in some areas a deficit in the providers offering these services, resulting in members traveling great distances to receive the vaccine. To address this issue, we have increased in the level of benefits for these vaccinations.
2010 Service Benefit Plan Benefits for the Seasonal Influenza and H1N1 Vaccines
In 2010, benefits for the seasonal influenza and H1N1 vaccines will be provided in a similar manner to the 2009 benefit. Standard Option copayments for visits to specialists will increase to $30 and Basic Option specialist copayments will increase to $35. Members receiving the seasonal influenza and/or H1N1 vaccine from a Non-participating provider would continue to be responsible for any difference between our allowance and the billed amount.
Members receiving the vaccine in 2009 and 2010 at any retail pharmacy would receive the vaccine at no charge, whether the pharmacy is a Preferred pharmacy that participates in our vaccine network or not.
Learn more about H1N1 and Seasonal Flu:
2009 Service Benefit Plan Benefits for the Seasonal Influenza and H1N1 Vaccines
Effective October 1, 2009, Preventive Care Benefits will be provided for the vaccines when provided in accordance with CDC guidance and any applicable U.S. Food and Drug Administration (FDA) licensure at the following levels for the remainder of 2009. These benefits will apply to the vaccine administered nasally and by injection and are retroactive to October 1, 2009.
Details about member responsibility is provided below and will apply to both seasonal flu and the H1N1 vaccine.
Standard Option:
Member responsibility for services provided to an adult:
- Preferred/Participating/Non-participating physician, other health care provider, or outpatient facility clinic*: The member pays a $20 copayment for the associated office visit (no deductible); nothing for the immunization or administration
- For Non-participating providers, members are also responsible for any difference between the Plan allowance and the billed amount.
Member responsibility for services provided to a child up to age 22:
- Preferred/Participating/Non-participating provider, including outpatient facility clinics*: member pays nothing (No deductible)
*For Non-participating providers, members are responsible for any difference between the Plan allowance and the billed amount.
Basic Option:
Member responsibility for services provided to an adult:
- Preferred/participating/Non-participating primary care provider, other health care professional, or outpatient facility clinic*: the member pays a $25 copayment for the associated office visit: nothing for the immunization or administration
- Preferred/Participating/Non-participating specialist provider*: the members pays a $30 copayment for associated office visit; nothing for the immunization or administration
*For Non-participating providers, members are also responsible for any difference between the Plan allowance and the billed amount.
Member responsibility for services provided to a child up to age 22:
- Preferred/Participating/Non-participating provider, including outpatient facility clinics*: member pays nothing (No deductible)
*For Non-participating providers, members are responsible for any difference between the Plan allowance and the billed amount.
Basic Consumer Option:
Member responsibility for services provided to an adult:
- Preferred/Participating/Non-participating provider, including outpatient clinics*: member pays nothing
*For Non-participating providers, members are responsible for any difference between the Plan allowance and the billed amount.
Member responsibility for services provided to a child up to age 22:
- Preferred/Participating/Non-participating provider, including outpatient facility clinics*: members pays nothing
* For Non-participating providers, members are responsible for any difference between the Plan allowance and the billed amount.