A Message from BCBSTX Concerning Coverage for H1N1 Vaccination

Tip Date: 2009-09-23

As you are aware, the new vaccine for the H1N1 (swine) flu virus will be available soon. The vaccine is being provided at no cost by the U.S. government; however, health care providers may charge their customary fees for administering the vaccination.

Members’ medical benefits vary by employer group, plan and type of coverage. In order to ensure that our members get the best treatment available, Blue Cross and Blue Shield of Texas (BCBSTX) has implemented a policy to cover the administration of the vaccine for members of our fully insured health plans without regard to whether their current plan covers vaccinations. We will cover this administration fee without applying it to their deductible or coinsurance. We will also work proactively with all the employers we work with who have self-funded employer health benefit plans, to recommend they adjust their benefit coverage to also cover administration of the vaccine.

This communication relates to the H1N1 flu (previously called swine flu) vaccine only. Coverage for other vaccines will be in accordance with the individual’s plan.

In order to benefit from this special coverage, a member must receive the vaccination from a BCBSTX network provider. When using a provider that is not in the BCBSTX network, normal benefit coverage will apply.

This coverage will be available for the five priority populations the Centers for Disease Control and Prevention (CDC) recommends receive the vaccine first:
   1. Pregnant women
   2. People who live with or care for children younger than 6 months of age
   3. Healthcare and emergency medical services personnel
   4. Persons between the ages of 6 months through 24 years
   5. People ages 25 through 64 years who have chronic health disorders or compromised immune        systems.

Federal employees and retirees covered by the Blue Cross and Blue Shield Government-wide Service Benefit Plan (Federal Employee Program or FEP^®) will also receive benefits for the administration of the H1N1 vaccine in 2009 and in 2010.

Please advise your employees of this decision. For your convenience we have attached a Frequently Asked Questions documentyou can share with your employees.

BCBSTX continues to closely monitor the H1N1 flu and, as needed, will provide updates about any potential impact H1N1 will have on the services we provide to employers and members. BCBSTX is ready to respond if an outbreak significantly impacts any of our service areas, and we have placed our own emergency response measures into effect to protect our employees.