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Seasonal Flu Coverage and Benefits
Whether you are covered for the seasonal flu vaccine depends on the type of Independence Blue Cross coverage you have. Refer to the chart below to see what your plan covers and find out where you should go to get vaccinated.
Please note: The following list may not be comprehensive. If you do not see your plan here, please call Customer Service at the number on the back of your ID card for coverage information.
Flu vaccine coverage chart
|Your plan||Where you can go for a vaccine||Your coverage for the seasonal flu vaccine|
Keystone 65 HMO
Personal Choice® PPO
Personal Choice 65SM
Coverage for the seasonal flu vaccine depends on whether your plan includes coverage for immunizations.
If your plan covers immunizations:
If your plan does include coverage for immunizations and you paid for your influenza vaccine, you may submit a Seasonal Influenza Reimbursement Form.
If you do not know whether your plan covers immunizations, call Customer Service at the number on the back of your ID card.
Traditional Blue Cross® and Blue Shield®
The injectable flu vaccine is covered in accordance with your current benefits plan for routine immunizations. Benefit restrictions as well as applicable deductible and coinsurance requirements may apply.
Please refer to your Summary of Benefits for more information, or call the Customer Service number on the back of your ID card.
Please Note: For members who have 100 percent coverage for services in accordance with the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010, no cost-share (i.e., copayments, deductibles, coinsurance) should be applied for the vaccine and administration of the vaccine when it is administered by an in-network provider.
Coverage is subject to the terms and conditions of the applicable benefit plan. Individual benefits must be verified.
You do not need to pay an up-front fee when you get your flu vaccine at a participating location or wellness event such as those offered by employers for their employees when facilitated by Maxim Healthcare Services, CVS, or Rite Aid. See the complete list of locations that do not require out of pocket expense for the flu vaccine.
If you get your flu vaccine at a location other than those listed above, you may have to pay an up-front fee. Independence Blue Cross members with HMO, POS, and PPO plans who receive their vaccine at a non-participating provider may file a reimbursement form to receive reimbursement for their out-of-pocket amount of up to $25 per member, per vaccine. Medicare Advantage members with Part B coverage are eligible for reimbursement of the full out-of-pocket amount for vaccines administered.
To receive your reimbursement, complete the form below and mail it, along with a copy of your receipt, to:
Keystone Health Plan East / Keystone 65 HMO
P.O. Box 69353
Harrisburg, PA 17106-9353
Personal Choice® / Personal Choice 65SM PPO
P.O. Box 69352
Harrisburg, PA 17106-9352
* Use the Provider Finder to locate participating retail health clinics (select “Urgent Care Center & Retail Health Clinic”).