Seasonal Flu Program – Frequently Asked Questions
Questions About the Seasonal Flu Shot Program
- Who's eligible for a seasonal flu shot at no cost?
A: In most cases, eligible members with preventive care benefits can get a seasonal flu shot, subject to any applicable copay, deductible or coinsurance, if they're enrolled in one of the following plans: 1
- BCBSNC group and individual plans with preventive care benefits
- Blue Medicare HMOSM
- Blue Medicare PPOSM
- Blue Medicare SupplementSM
- North Carolina State Health Plan
- North Carolina Federal Employee Program
- Where can I get a seasonal flu shot that's covered?
A: Eligible members with preventive care benefits can get a seasonal flu shot during flu season, while vaccine supplies last, at any of the following locations: 2
- Worksite clinic2 — Some members may get a flu shot where they work. Many employer groups may have free on-site flu shot clinics. Employers determine if family members may also participate. Members of a group plan should contact their Human Resources or benefits department for more information.
- Doctor's office — Members who get other care in addition to the flu shot will have to pay any applicable copay, coinsurance or deductible amounts. To find an in-network doctor, visit Find a doctor.
- In-network immunizing pharmacists (NOT pharmacies, except participating MinuteClinics) — Eligible members may go to an in-network, immunizing pharmacist (NOT pharmacy) or MinuteClinic to get a flu shot. A limited number of pharmacists have contracted with BCBSNC to give the flu shot. Only eligible members ages 14 and older may get flu shots from pharmacists. Some members may pay a copay, deductible or coinsurance, depending on their specific benefits. To find in-network pharmacists, visit the Find a doctor section of our site and verify the ZIP code for your search. Begin typing "Pharmacist" into the search box and under Specialties, select "Pharmacist (Flu & Other Limited Injections) - Convenience Care (Facilities)". To find a participating Minute Clinic, select "Convenience Care Center" under Advanced Search.
- In-network health department: Eligible members may visit an in-network health department to get a flu shot. Some members may pay a copay, based on their benefits. Members who get other care as well as the flu shot will have to pay any applicable copay or deductible and/or coinsurance amounts.
- Why can't all pharmacists give flu shots?
A: Immunizing pharmacists in the BCBSNC network can give vaccines, such as the flu shot, in retail pharmacies. In order for a vaccine received in a pharmacy to be covered, it must be given by an immunizing pharmacist in our network. Immunizing pharmacists will only give flu shots to eligible members ages 14 and older. To find an in-network immunizing pharmacist, visit Find a doctor, and verify the ZIP code for your search. Begin typing "Pharmacist" into the search box and under Specialties, select "Pharmacist (Flu & Other Limited Injections) - Convenience Care (Facilities)".
- When can I get a flu shot?
A: Members should contact their doctor, employer, or in-network pharmacist to find out when flu shots will be given and to make an appointment.
- How do I know if I'm eligible to get a seasonal flu shot?
A: If you don't know whether your BCBSNC plan offers 100% preventive care benefits, or whether your preventive benefits are subject to a deductible, check your BCBSNC Member Guide. You can also contact your benefits manager or call BCBSNC Customer Service at the toll-free number listed on your BCBSNC ID card.1
- Can I get my flu shot from a doctor who's not in the BCBSNC network?
Yes, but services along with flu shots will either be paid at the out-of-network benefit level or they won't be covered. To find an in-network doctor, visit Find a doctor.
- What if I'm a member but I live outside North Carolina?
Maxim Healthcare Services (Maxim) may have flu shot clinics at worksites outside North Carolina. Members may be able to get flu shots at those worksite clinics. If eligible members with preventive care benefits go to an in-network doctor in their state, they won't be charged for the flu shot. Some members may pay a copay depending on their specific benefits.
- Why would some eligible members be charged when they get a seasonal flu shot?
There are a few likely reasons. Some BCBSNC plans call for a member copay for an office visit., Some plans don't include preventive care benefits. And some require that a deductible to be met before preventive care services are paid at 100 percent. In any case, the member may be responsible for paying an out-of-pocket amount. If an eligible member visits their doctor only for a flu shot, the copay, is often waived. But, if the member sees a doctor for any other reason during the flu shot visit, an office visit copay, is required.
- I'm not a BCBSNC member. I don't have preventive care benefits. Can I get a covered seasonal flu shot?
Non-BCBSNC members, or ineligible members, can get a seasonal flu shot at a Maxim flu clinic for an out of pocket cost of $30. Flu shots may be available at a public health department. Cost varies and may be covered by private insurance or Medicare.
- I forgot to bring my BCBSNC member ID card to my employer's worksite flu shot clinic and had to pay $30 for my flu shot. How do I get paid?
To request payment, e-mail firstname.lastname@example.org. Provide your BCBSNC insurance information, which can be found on your BCBSNC id card. This includes your ID number, two-digit dependent number and group number (if applicable). You should get a check from Maxim in approximately 6-8 weeks.
- Is FluMist® covered?
FluMist isn't available at worksite flu shot clinics given by Maxim. It's only appropriate for healthy people between ages 2 — 49 who aren't pregnant. To get FluMist, you should see your doctor or in-network immunizing pharmacist. If you're an eligible member with preventive care benefits and you visit your doctor only to get FluMist, you will likely not be charged in. An office visit copay may still apply for some members. See your BCBSNC Member Guide for your specific preventive care benefit information or call BCBSNC Customer Service at the toll-free number listed on your BCBSNC ID card.
- What about the flu shot for children?
The flu shot for children under the age of 4 will only be available in doctor offices. Maxim will only give flu shots to children ages 4 — 17 who are with a parent or guardian. Pharmacists will only give the flu shot to people ages 14 and older.
- What if I have more questions about the seasonal flu vaccine?
The nurses at Health Line Blue are available to answer your questions about the flu or other health questions at any time at 1-877-477-2424.
- What if I'm not feeling well and I'm unsure where to go for care?
The nurses at Health Line Blue can help you decide the most appropriate place of service for your specific health concern. Call anytime at 1-877-477-2424. If you're not sure you have the flu, please refer to our symptom decision chart at bcbsnc.com/urgent (or bcbsnc.com/urgente for Spanish).
Questions About the Seasonal Flu Vaccine
- Who should get the seasonal flu vaccine?
The Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of 6 months get a yearly flu shot. 3 The flu, also known as influenza, 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 spread. You can also get the flu from those who've been exposed, but haven't yet developed symptoms. This means that you can be contagious and not even know it.
While everyone should get a flu vaccine each flu season, it's highly important that certain people get vaccinated either because they are at high risk of having serious flu-related complications including:3
- Children younger than five, but especially children younger than two
- Pregnant women and women up to two weeks after the end of pregnancy
- Residents of nursing homes and long term care facilities
- American Indians and Alaska Natives
- Adults 65 years of age and older
- People of any age with certain chronic medical conditions
- People who are morbidly obese with a body mass index of 40 or greater
- Who shouldn't get the flu vaccine? 3
Some people shouldn't get the flu shot without talking their doctor first. This includes:
- Anyone with a severe allergy to chicken eggs
- People who've had a severe reaction to an influenza vaccination in the past
- People who have developed Guillain-Barré syndrome within six weeks of getting an flu vaccine
- Children less than six months of age
- Can I get the flu from the flu shot?
No, you can't get the flu from the flu shot since it's made from viruses that are not alive and are not infectious. The flu strain changes each year, so even if you got a flu shot last year, you'll need to get another one this year.
- Can I still get the flu after get the shot?
Yes. Like other vaccines, the flu vaccine isn't 100 percent effective. The vaccine's effectiveness depends on a person's age and health status as well as a "match" to the flu virus in the community. However, even if you get the flu, it is possible that it will not be as severe and your risk of complications is lessened. It takes about two weeks for the flu shot to take effect. During this time, you'll be just as likely to catch the flu as people who haven't gotten the flu shot. Getting the annual flu shot as soon as it's available is the best way to prevent the flu.
- Are there any side effects from the flu shot?
Almost all people who get the flu shot have no serious problems from it. The most common side effects are soreness, redness or swelling where the shot was given, Some people get a low grade fever and aches. If they happen, side effects begin soon after the shot is given and usually last one to two days. Rare side effects include severe allergic reactions. Anyone who is allergic to chicken eggs should avoid being vaccinated, since the virus used is grown in these eggs. If you have any problems after receiving your flu shot, see your doctor right away. 3
- Does the flu shot contain thimerosal?
Thimerosal is a mercury based preservative that prevents the growth of germs and bacteria. Based on research, the FDA, CDC and NIH have determined thimerosal is safe. Flu shots given in most flu clinic settings use multi-dose vials that contain thimerosal. Single dose vials do not contain thimerosal. For more information please refer to the following link: http://www.cdc.gov/flu/protect/vaccine/thimerosal.htm.
1 Seasonal flu shots are available for eligible members and covered at 100 percent for those members with a non-grandfathered plan. Members in self-funded plans should check with their plan administrator to determine if the vaccine and FluMist are covered benefits and, if covered, where they can get the benefit at the lowest cost.
2 Each seasonal flu clinic has been given a set amount of shots. Shots will be given on a first-come, first-served basis until the supply is gone. A parent or legal guardian must be wtih children ages 4-17 and give written authorization (children under 4 should see their doctor). The flu shots will be given by agents of Maxim Health Systems. Members should refer to their Benefit Booklet for more information about their preventive care benefits. In the event that the Centers for Disease Control and Prevention (CDC) recommends that flu shots be given to "priority groups" before the general public, Maxim will give priority to those who fit the CDC's high-risk standards.
3 "Key Facts About Seasonal Flu Vaccine." Centers for Disease Control and Prevention, http://www.cdc.gov/flu/protect/keyfacts.htm (accessed May 2016)
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