Independence Blue Cross (IBX) and Independence Administrators continue to offer coverage for routine vaccines and immunizations such as influenza (flu) and respiratory syncytial virus (RSV), as well as coronavirus disease 2019 (COVID-19) based on the criteria below.
Coverage for the COVID-19 vaccine
COVID-19 vaccines and their administration are covered as a preventive service at no cost when members present their ID card at an in-network provider's office, a retail health clinic, or an in-network pharmacy. COVID-19 vaccines are covered for individuals ages 6 months and older.
Some states may require a prescription to receive the COVID-19 vaccine at an in-network pharmacy. Note: An office visit cost-share may apply if a vaccine prescription is obtained during a non-preventive visit.
Coverage for the Influenza (flu) vaccine
The flu vaccine is covered at no cost when members present their ID card at an in-network provider's office, a retail health clinic, or an in-network pharmacy. Flu vaccines are covered for individuals ages 6 months and older.
If members pay out of pocket for the flu vaccine, they will be reimbursed for the cost up to $50.
Coverage for Respiratory Syncytial Virus (RSV) immunizations
RSV immunizations are covered for members ages 8 to 19 months, 18 years and older, and those who are pregnant. Non-pregnant members ages 18 to 49 may be subject to a cost- share.
Coverage for adults is dependent on the member's product. Health care providers are encouraged to discuss options with their patients, particularly those ages 60 or older, to identify the most suitable options. Providers can verify member coverage through the Provider Engagement, Analytics & Reporting portal using the Practice Management application.
For more information about vaccinations and immunizations, please refer to the 08.01.04ag: Routine/Non-routine Vaccines policy. Please note that over time, this policy link may expire as policies become updated. If you are unable to open a policy link, please refer to the Medical Policy Portal for the most up-to-date policy information.
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