Benefits for Immunizations/Vaccinations and Their Administration Under the Pharmacy Plan
Effective July 1, 2013, members and dependents who are not covered by Medicare, will be allowed to obtain their routine immunizations and vaccinations at the pharmacy, in accordance with the current Centers for Disease Control and Prevention guidelines. In the past, these were only available under the health plans. The immunization and/or vaccination and the administration fee will now also be covered under the pharmacy benefits at 100%, if the services are provided by a Network Pharmacy.
Participants will be subject to non-Network benefits and may be balanced billed for amounts above the Allowed Charges, if utilizing the services of a non-Network pharmacy.
The existing immunization/vaccination and administration benefits under the health plans shall remain the same. Please note that under the health plans:
- Only Network Physicians/Providers/Pharmacists may provide these services.
- Mid-Level practitioners such as Physician Assistants or Nurse Practitioners practicing at a free-standing ambulatory care clinic located at a pharmacy may or may not be participating.
- NON-NETWORK PHARMACISTS ARE NOT RECOGNIZED AND are not covered.
Immunizations/Vaccinations covered under pharmacy benefits when a Network Pharmacy is used:
Rabies, Human Diploid
Rabies, PF Chick-EMB Cell
Smallpox (Vaccinia) Vaccine
Tetanus, Diphtheria, Pertussis