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 Health Choice for Children
- 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 and search for “All Primary Care” under Specialty.
- 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 search for "Pharmacist (Flu & Other Limited Injections)" under Specialty. To find a participating CVS Minute Clinic, search for "Convenience Care Center" under Specialty.
- 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 the Find a doctor section on our site, and search for “Pharmacist (Flu & Other Limited Injections)” under Specialty.
- 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.
- I don't have preventive care benefits. I'm not a BCBSNC member. 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 public health department. Cost varies and may be covered by private insurance or Medicare.
- 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 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?
If you do not bring your BCBSNC member ID card and driver's license or other photo identification to your worksite flu shot clinic, Maxim Healthcare Services does not have a way to verify your eligibility to receive a covered flu shot. Therefore, you will be treated as a non-member and will have to pay $30 for your flu shot. Maxim will provide you with a receipt for your payment.
To request reimbursement, contact Keith Ramalho at Maxim at (410) 910-1376 or e-mail him at firstname.lastname@example.org. Provide him with 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 9 will only be available in physician offices. Maxim will only administer flu shots to children ages 9—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?
You can visit our website at bcbsnc.com/flu for more information, or call BCBSNC Customer Service at the phone number listed on your BCBSNC ID card. In addition, the nurses at Health Line Blue are available to answer your 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?
Questions About the Seasonal Flu Vaccine
- Who should get the seasonal flu vaccine?
BCBSNC encourages most people to receive the seasonal flu vaccine. 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.
The Centers for Disease Control and Prevention (CDC) recommends that you get an annual flu shot if you fall under one of the following categories: 3
- Anyone who wants to decrease their risk of catching the flu
- Children (6 months old to 19 years old)
- Pregnant women
- People 50 years of age and older
- People of any age with certain chronic medical conditions
- People who live in nursing homes or other long-term care facilities
- People who live with or care for those at high risk for complications from the flu, including:
- Health care workers
- Household contacts of persons at high risk for complications from the flu
- Household contacts and out-of-home caregivers of children less than 6 months of age
- 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 a fever (you should wait until you've recovered before you get a flu shot)4
- Can I get the flu from the vaccine?
Contrary to popular myth, you can't get the flu from the vaccine 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.
- What are the chances that providers will run out of flu vaccines this year?
While there are no guarantees of flu vaccine availability, public health officials have determined that supplies of the vaccine are plentiful for 2011 and early 2012.
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 Seasonal Influenza (Flu)." Centers for Disease Control and Prevention, September 2010, http://www.cdc.gov/flu/keyfacts.htm (June 2011)
4 "Key Facts About Seasonal Flu Vaccine." Centers for Disease Control and Prevention, September 2010 http://www.cdc.gov/flu/protect/keyfacts.htm (June 2011)
®, SM Marks of the Blue Cross and Blue Shield Association. SM1 Mark of Blue Cross and Blue Shield of North Carolina. FluMist® is a registered trademark of MedImmune, LLC.