Stick it to the Flu® - Frequently Asked Questions

Questions About the Seasonal Flu Shot Program

Who's eligible for a seasonal flu shot at no charge?

A: In most cases, eligible members with preventive care benefits can receive a seasonal flu shot, subject to any applicable copayment, 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 clinic — Some members may receive a flu shot where they work. Many employers have chosen to host on-site flu shot clinics at no cost to the employee / member. Employers determine if family members may also participate. Members of a group plan should contact their Human Resources or benefits department for more information.
  • Physician's office — Members who receive other services in addition to the flu shot will be required to pay any applicable copayment, coinsurance or deductible amounts. To find an in-network provider, visit Find a doctor.
  • Participating immunizing pharmacists (NOT pharmacies, except participating CVS MinuteClinics) — Eligible members may go to an in-network, immunizing pharmacist (NOT pharmacy) or CVS MinuteClinic to receive a flu shot. A limited number of pharmacists have contracted with BCBSNC to administer the flu shot. Only eligible members ages 14 and older may receive flu vaccinations from pharmacists. Some members may pay a copayment, deductible or coinsurance, depending on their specific benefits. To find in-network pharmacists, visit the Find a doctor section of our site and under Advanced Search select "Pharmacist (Flu & Other Limited Injections)" under Convenience Care. To find a participating CVS Minute Clinic, select "Convenience Care Center" under Advanced Search.
Why aren't all pharmacists able to provide covered flu shots?

A: Immunizing pharmacists in the BCBSNC network are licensed and certified to provide and administer vaccines, such as the flu shot, in retail pharmacies. In order for a vaccine received in a pharmacy to be covered, it must be administered by an immunizing pharmacist participating in our network. Immunizing pharmacists will only administer flu shots to eligible members ages 14 and older. To find a participating immunizing pharmacist, visit Find a doctor, and under Advanced Search select �Pharmacist (Flu & Other Limited Injections)� under Convenience Care.

When can I get a flu shot?

A: Members should contact their physician, employer, or participating pharmacist to find out when flu shots will be administered and to schedule an appointment.

How do I know if I'm eligible to receive a covered seasonal flu shot?

A: You're eligible if you're a BCBSNC member with preventive care benefits. If you're unsure whether your BCBSNC individual or group plan includes preventive care benefits, or whether your preventive benefits are subject to a deductible, check your BCBSNC Benefit Booklet, contact your plan administrator or call BCBSNC Customer Service at the toll-free number listed on your BCBSNC ID card for more information.1

Can I get my flu shot from a doctor who's not in the BCBSNC network?

Yes, but services will either be paid at the out-of-network benefit level or they won't be covered. Only physicians in the BCBSNC network are participating in the BCBSNC flu shot program. To find an in-network provider, visit Find a doctor.

What if I'm a member but I live outside North Carolina?

Some large employers coordinate with Maxim Healthcare Services to schedule flu shot clinics at their worksites outside North Carolina. Members may be able to receive flu shots at those worksite clinics. If eligible members with preventive care benefits go to an in-network provider in their state, they won't be charged for the flu shot, although some members may pay a copayment, deductible or coinsurance, depending on their specific benefits.

Why would some eligible members be charged when they receive a seasonal flu shot?

There are several possible reasons. Some BCBSNC plans require a member copayment for an office visit, some don't include preventive care benefits and some require that a deductible must 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 with preventive care benefits goes to their doctor only for a flu shot, the copayment, deductible or coinsurance is typically waived. However, if the member sees a doctor for any other reason during the flu shot visit, an office visit copayment, deductible or coinsurance is required.

Who administers the flu shot?

BCBSNC has contracted with Maxim Healthcare Services to provide the flu shots at employer worksite clinics if a flu shot clinic is scheduled. Otherwise, a participating physician, in-network pharmacist or CVS MinuteClinic will administer flu shots, depending on the location and set up.

I'm not a BCBSNC member. I don't have preventive care benefits. Can I get a covered seasonal flu shot?

Under the BCBSNC program, seasonal flu shot benefits are limited to eligible members with preventive care benefits.1 Non-BCBSNC members, or those who don't qualify as eligible members, can receive a seasonal flu shot at a Maxim flu clinic for an out of pocket cost of $30 or at a public health department.

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 reimbursed?

To request reimbursement, e-mail bcbsnc@maxhealth.com. Provide your BCBSNC insurance information, including your ID number, two-digit dependent number and group number (if applicable), as well as the date and location of the flu shot clinic you attended. You should receive a check from Maxim in approximately 6-8 weeks.

Is FluMist® covered?

FluMist isn't available at worksite flu shot clinics administered by Maxim. It's only appropriate for healthy individuals between ages 2—49 who aren't pregnant. To receive FluMist, you should see your physician. If you're an eligible member with preventive care benefits and you visit your physician for the sole purpose of receiving FluMist, you won't be charged in most cases. An office visit copayment, deductible or coinsurance may still apply for some members. See your BCBSNC Benefit Booklet 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 pediatric flu shot?

The pediatric flu shot for children under the age of 4 will only be available in physician offices. Maxim will only administer flu shots to children ages 4—17 who are accompanied by a parent or guardian. Pharmacists will only administer the flu shot to individuals 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 should get a flu shot each year.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 transmitted from people who are already infected. 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 especially 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
  • 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?

Some individuals shouldn't receive the flu shot without consulting their health care provider first, including:

  • 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
  • Anyone with a moderate to severe illness with or without a fever (you should wait until you've recovered before you get a flu shot)2

Can I get the flu from the flu shot?

Contrary to popular myth, you can't get the flu from the flu shot since it's made from dead and inactive viruses that are noninfectious. The flu strain changes each year, so even if you received a flu shot last year, you'll need to get another one this year to remain protected.

Can I still get the flu after receiving the vaccine?

Yes. Like other vaccines, the flu vaccine isn't 100 percent effective and doesn't take effect until approximately two weeks after it's received. During this time, you'll be just as susceptible to the flu as individuals who haven't received the vaccination. Still, the best option to prevent the flu is to get an annual flu shot

Are there any side effects from the flu shot?

The viruses in the flu shot aren't active, so you can't get the flu from a flu shot. Almost all people who receive the influenza shot have no serious problems from it. The most common side effects are soreness, redness or swelling where the shot was given, a low grade fever and aches. These potential side effects begin soon after the shot is administered and usually last one to two days. Rare side effects include severe allergic reactions. Anyone 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 health care provider immediately. 4

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 receive the benefit at the lowest cost.

2 Each seasonal flu clinic has been allocated a supply of vaccine. Shots will be given on a first-come, first-served basis until the supply is depleted. A parent or legal guardian must accompany children ages 9-17 and provide written authorization (children under 9 should see their physician). The flu shots will be administered by representatives of Maxim Health Systems, a division of Maxim Healthcare Services. 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 go to "priority groups" before the general public, Maxim will give priority to those who fit the CDC's high-risk criteria.

3 "Key Facts About Influenza (Flu) & Flu Vaccine." Centers for Disease Control and Prevention, http://www.cdc.gov/flu/keyfacts.htm (accessed July 2014)

4 "Key Facts About Seasonal Flu Vaccine." Centers for Disease Control and Prevention, http://www.cdc.gov/flu/protect/keyfacts.htm (accessed July 2014)


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