What You Need To Know About Flu Shot Season

Flu season is right around the corner, so here is information to help members get their flu shot.  Seasonal immunizations are covered according to the group’s Preventive Care benefit for immunizations using in-network providers.  There are no immunization benefits available through out of network providers.

Members have several ways to access their immunizations:

  • Visit a contracted In-Network provider who will bill us for the immunization directly.  The immunization is covered according to each group’s specific Preventive Immunization benefit.  There may or may not be an office visit charge associated with the immunization in which case the member would be responsible for their cost share of the office visit per their specific group plan.  We recommend contacting the provider in advance for specifics.
  • Members can visit a contracted Express Scripts pharmacy, however they may need to pay for the immunization at the time of service, complete a Premera claim form and submit the claim for direct reimbursement.
    • Express Scripts will provide the following immunizations: Seasonal Flu – Seasonal Immunization, Adult Shingles – Seasonal Immunization, Pneumococcal Immunization – Seasonal Immunization, Gardasil, DTaP for diphtheria, tetanus, and acellular pertussis (whooping cough) is also covered under the member’s Preventive Care benefits when obtained at an Express Scripts contracted pharmacy. Each pharmacy develops their own rules when it comes to vaccines, specifically with children’s vaccines. Individual pharmacies will set their own age limits. Members should be advised to contact the pharmacy to determine if their child is able to obtain a flu shot there.
  • Premera also contracts with specific vendors for worksite benefit administration (in other words: on site Flu shot clinics).  PBC requires a separate claim for each member and these vendors have agreed to bill Premera for each individual member and not charge the patient up front.   The list of vendors we are currently contracted with can be viewed here.  It is up to each vendor to work with the customer to determine availability and if an onsite event is appropriate given the group’s size and location.