Flu Immunization Coverage

December 12, 2006

Independence Blue Cross (IBC) has made some changes to our coverage of influenza vaccines to make it easier for our HMO, POS, and PPO managed care members to obtain vaccinations this flu season (October 1, 2006 through March 31, 2007).

·              Waiver of referral requirements. We have waived the referral requirements for HMO and POS members during this flu season. Managed care members, whose IBC benefit program contains a benefit for immunizations, may obtain their influenza vaccines from their primary care physicians (PCPs) or participating specialists without a referral.

·              Reimbursement up to $25. New for this year, managed care members who receive an influenza vaccine in a setting other than a physician's office or hospital (e.g., in a supermarket, pharmacy, etc.) are eligible for reimbursement of their out-of-pocket costs up to $25. Member reimbursement for this type of service requires submission of the paid receipt or bill, along with a specially-designed claim form, which can be obtained by calling Member Services.

·              Coverage of FluMist^TM. FluMist, an FDA-approved intranasal influenza vaccine, will be covered for commercial managed care members under their medical benefits that contain a benefit for immunizations. FluMist is not covered for any Medicare lines of business.

·              Self-referred coverage under routine immunization benefits. Members who use the self-referred POS out-of-network option for the influenza vaccines obtained at a physician's office or a hospital will be covered under the routine immunizations benefit, if available.

·              No PPO deductible. Deductibles will not apply to influenza vaccinations for PPO members. In addition, coinsurance will not apply to members who receive the vaccine in-network.

Coverage of the influenza vaccine under all programs is subject to any applicable age limits, benefit maximums, deductible, and coinsurance requirements.

For more information regarding flu immunization coverage, please contact your IBC Broker Representative.

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield. Independent Licensees of the Blue Cross and Blue Shield Association.