COVID-19 vaccine: here’s what you need to know
December 30th, 2020
We understand how important it is for your clients to have reliable information about the availability of FDA-emergency use authorized vaccines, while maintaining the fight against COVID-19. We are monitoring developments closely and will make regular updates to our COVID-19 Resources site for brokers and employers.
Blue Shield of California members can receive COVID-19 vaccinations, considered a preventive service, at no member cost share and with no provider order. Coverage will be provided for both in-network and out-of-network providers through the duration of the COVID-19 Public Health Emergency.
During the initial phase of vaccinations, the cost of the vaccine itself will be covered by the federal government, but the cost of the administration of the shots will be the responsibility of health plans. For fully-insured plans, Blue Shield will cover this cost. For self-funded plans, the plan will be responsible for reimbursing the cost of administration. For network providers, reimbursement will be based on the contracted rate, and for non-network providers, plans are required to reimburse a “reasonable” rate. According to Center for Medicare & Medicaid Services (CMS), the Medicare reimbursement rate will be considered reasonable. That rate will be $16.94 for the first dose and $28.39 for the second dose, when applicable.
Distribution and Timing
- The first doses of the vaccine have started to arrive in California.
- According to the CDC, people working in direct health care or in long-term care settings will receive first priority. Those with high-risk medical conditions will receive second priority. The CDC will provide directions for distribution. However, states are expected to play a big role in the distribution strategy.
- Health plans must provide coverage for a qualifying coronavirus preventive service no later than 15 business days after the date that the Advisory Committee on Immunization Practices (ACIP) or the US Preventive Services Task Force (USPSTF) makes an applicable recommendation. Coverage is not dependent on type of FDA approval or authorization. Grandfathered (pre-ACA) plans may be exempt from this requirement, and plan sponsors should refer to their health plan documents.
Safety is still the most effective way to fight COVID-19
The availability of a safe and effective vaccine is just the first step in bringing the pandemic to an end. Distributing a vaccine to 40 million Californians will take tremendous coordination from state and local governments, with the help of health plans like Blue Shield of California.
Communications with similar essential information will be sent to employers and members as well, beginning December 17, and timely information will be posted on www.blueshieldca.com.