NC Healthcare Coverage Blog

Program Information

BCBSNC will again conduct a flu shot promotion this fall, but it will be different from what we’ve offered in recent years. Here are some of the important points about our 2007 flu shot program:

• This year we’re teaming with the North Carolina Medical Society to promote flu
  shots in physicians’ offices. BCBSNC will NOT offer flu shots in retail clinics,
  pharmacies or regional centers.
• We won’t be paying for ASO groups to offer flu shots this year.
• We will continue to offer a worksite flu shot program to employer groups that meet certain criteria. Worksite flu shots will be offered at no cost to fully insured groups. ASO groups will pay $24.50 per flu shot at worksite clinics.

General Questions

Who is eligible for a flu shot?

In most cases, members with preventive health care benefits are eligible to receive a flu shot at no charge, including members of the following plans:

• BCBSNC group and individual plans with preventive benefits
• PARTNERS Medicare Choice
• PARTNERS Medicare Options
• North Carolina State Health Plan (CMM and PPO)
• North Carolina Federal Employee Program

Members age 18 and older must present their BCBSNC member ID card at the time of the shot. If they do not shot a BCBSNC member ID, they will be required to pay $30 to get the flu shot. Dependent children ages 9 to 17 must be accompanied by a parent or guardian. Dependent children under the age of 9 must contact their pediatrician or physician’s office to obtain a flu shot administered in a children’s dose.

How do I know if I’m eligible?

Members should check their BCBSNC benefits booklet to see if preventive health care benefits or covered, or they may call the benefits department where they work.

When and where can I receive a flu shot?

Members may receive their shot in October or November (while vaccine supplies last) at one of the following locations:

• Physician’s office. Members may visit their doctor for a flu shot, either by scheduling an appointment or by visiting during the physician’s flu shot clinic. Members with preventive benefits will not be charged for the flu shot, although some members may pay an office copayment, depending on their specific
  benefits. Members who receive other services at their physician’s office in addition to the flu shot will be required to pay any applicable copayment, coinsurance or deductible.
• Worksite clinic. Some members may receive a flu shot where they work. Many employer groups have chosen to host worksite clinics this year. Members of a group plan should contact their benefits department or Human Resources to find out if their employer is hosting a worksite clinic.

When does the program begin and end?

Flu shots in physicians’ offices and at worksite clinics will take place in October and November as long as flu vaccine supplies last. Members should contact their physician or employer to find out when flu shots will be administered and to schedule an appointment, if necessary.

I’m a Medicare Supplemental subscriber. Can I still get a flu shot?

Yes. In fact, people over age 65 are considered “high risk�? and are especially encouraged to get a flu shot. Since BCBSNC is not offering retail clinics, you will need to go to your physician to get the shot this year.

I’m not a BCBSNC member. Can I get a flu shot, too?

Flu shots are limited to eligible BCBSNC, PARTNERS, State Health Plan and FEP members. However, non members can get a flu shot for $30 at physicians’ flu shot clinics. Maxim Healthcare Services, which will be administering the vaccines, only accepts cash or checks – no credit cards. Also, flu shots are available for the uninsured and general public at public health departments.

What if I am a BCBSNC member but live outside of North Carolina?

Some large employers will be coordinating with Maxim to schedule flu shot clinics at their worksites outside of North Carolina, and members may be able to receive flu shots at those worksite clinics. BCBSNC will not offer an out-of-state voucher program this year. If members go to a participating provider and they have preventive benefits, the flu shot will be covered.

Flu Shot Vaccine Questions:

Who should get the flu shot?

BCBSNC and the North Carolina Medical Society encourage most people to receive a flu vaccine. Influenza, or the “flu,�? can affect people of all ages as it spreads through the air from person to person. The virus can be as contagious as the common cold and is easily transmitted from people who are already infected. You can also get the flu from those who have been exposed, but have not yet developed symptoms. This means that you can be contagious and not even know it.

The Centers for Disease Control and Prevention recommends that you get an annual flu shot if you are 50 years of age or older, have a chronic illness such as heart disease, diabetes, kidney disorder, blood disorder, have a weakened immune system, will be past your third month of pregnancy during flu season or are likely to come in close contact with people at risk of serious influenza.

Who should not get the flu shot?

Anyone with a history of hypersensitivity to eggs or egg products should not receive a flu shot since the vaccine is grown in hens’ eggs. If you have specific questions about whether the flu vaccine is appropriate for you, please ask the nurses at the flu shot clinic or ask your health care provider.

Is FluMist covered?

FluMist is not available at the flu shot clinics that are being hosted by BCBSNC. Also, it is only appropriate for healthy individuals between the ages of 5 and 49. To receive FluMist, you should see your physician. If your health plan includes preventive health benefits, and you visit your physician for the sole purpose of receiving a flu shot, in most cases, you will not be charged. An office visit copayment may still apply for some members. See your benefit booklet for your policy details.

What are the chances that providers or employers will run out of flu vaccines this year?

While there are no guarantees of flu vaccine availability, public health officials have determined that supplies of the vaccine are plentiful for 2007.