HNE’s 2010-2011 Flu Policy
Posted on August 17, 2010
Influenza Virus/Flu Vaccine: HNE covers the flu vaccine for any member over six (6) months of age. The flu vaccine may be obtained through the PCP. If the PCP does not have flu vaccine, it may be obtained elsewhere, however, the member would have to pay for it and then submit for reimbursement. They will need to submit their itemized receipt to HNE attn: Member Services. We will then log their request and submit to Claims for processing. If the member pays for the flu shot out of pocket at a clinic, work etc….we will reimburse 100% of the charge. If the member gets this at their PCP office or an in-plan provider office and we are billed for the administration of the shot along with the actual immunization, an OV copay would apply. For GIC members, the flu shot is on the preventative code list for children up to the age of 18, which means no copay would apply.
HNE does NOT cover the Live Attenuated Influenza Vaccine/FluMist® as this is intranasally administered to “healthy” people 5-49 years of age who wish to avoid influenza. However, HNE has allowed coverage effective August 1, 2009 for FluMist (CPT 90660) for members aged 2-18.
