Stick it to the Flu® - State Health Plan FAQs
Questions About the Seasonal Flu Shot Program
- Where can I get a flu shot?
North Carolina State Health Plan (Plan) members, including retirees enrolled in the Enhanced 80/20 Plan, Consumer-Directed Health Plan and the Traditional 70/30 Plan, can receive a flu shot at no charge, while vaccine supplies last, at any of the following locations:
- Doctor's office — Plan members may either schedule an appointment for a flu shot or visit a doctor's flu shot clinic. If you go to your doctor's office and get the flu shot from a nurse, there won't be a charge for the flu vaccine. But, if your doctor gives the flu shot or if you receive other services in addition to the flu shot, you'll have to pay any applicable copay, coinsurance or deductible amounts.
- Worksite clinic 1 — Some Plan members may get a flu shot where they work and retirees may be able to get a flu shot at the agency from where they retired. Many state agencies have chosen to host employer worksite flu shot clinics this year. Members should contact their Health Benefit Representative to find out if their agency is hosting a worksite flu shot clinic, or check out the listing of all participating agencies on www.shpnc.org.
- In-network immunizing pharmacists — Available in limited locations, Plan members may go to a in-network pharmacist or MinuteClinic to receive a flu shot. In-network pharmacists have contracted with BCBSNC to administer shots covered by the State Health Plan, such as the flu shot. Only Plan members ages 14 and older may receive flu vaccinations from pharmacists. To find in-network pharmacists, 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)".
- How do I get a flu shot at no charge?
Members ages 18 and older must present their State Health Plan member ID card in order to get a flu shot. If you don't show your ID card, you'll be required to pay $30 for the flu shot. Dependent children ages 4 to 17 must be with a parent or guardian. Dependent children under the age of 4 must see their pediatrician or doctor to get a flu shot given in a child's dose.
- When can I get a flu shot?
Members should contact their doctor, employer, or participating pharmacist to find out when flu shots will be given and to schedule an appointment.
- Why can't all pharmacists give flu shots?
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)".
- Will my flu shot be covered if I go to an out-of-network doctor?
No. All vaccines, including the flu shot, are only covered when given by an in-network doctor. If you go to an out-of-network doctor for your flu shot, the service will not be covered and you will have to pay for all charges.
- My child is away in college in North Carolina, and does not have a primary care physician at school. Where can my child get a covered flu shot?
Plan members can receive a flu shot at no charge, while vaccine supplies last, at any of the following locations:
- Doctor's office — Plan members may either schedule an appointment for a flu shot or visit a doctor's flu shot clinic. If you go to your doctor's office and get the flu shot from a nurse, there won't be a charge for the flu shot. However, if your doctor gives the flu shot or if you receive other services in addition to the flu shot, you'll have to pay any applicable copay, coinsurance or deductible amounts.
- In-network pharmacists — Available in limited locations, Plan members may go to an in-network immunizing pharmacist or MinuteClinic to get a flu shot. In-network immunizing pharmacists have contracted with BCBSNC to give shots covered by the Plan, such as the flu shot. Only Plan members ages 14 and older may receive flu shots from pharmacists. To find in-network pharmacists, 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)".
- Is there a list of State Health Plan flu shot clinics?
Yes. Plan members should check with their Health Benefit Representative to see if they are hosting a worksite flu shot clinic or visit www.shpnc.org for a complete list of Plan flu shot clinics. Plan members can also get a flu shot at their doctor's office or, in limited locations, in a MinuteClinic or by an in-network, immunizing pharmacist. Only Plan members ages 14 and older may receive flu shots from immunizing pharmacists. To find participating MinuteClinics, 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)".
- What about members living outside North Carolina?
If a member goes to an in-network doctor in their state, the flu shot will be covered.
- My spouse and children are not covered under my plan. Can they get a flu shot too?
Under the State Health Plan program, flu shot benefits are only for members. Nonmembers can receive a flu shot at public health departments. The cost varies and may be covered by private insurance or Medicare.
- I don't have my BCBSNC member ID card at the employer's worksite flu shot clinic and had to pay $30 for my flu shot. How do I get paid?
If you do not bring your BCBSNC member ID card and photo ID to your worksite flu shot clinic, Maxim cannot check your eligibility to get a covered flu shot. So, you will be treated as a non-member and will pay $30 for your flu shot. Maxim will provide you with a receipt for your payment.
To request payment, e-mail email@example.com. 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). Also give the date and location of the flu shot clinic you visited. You should get a check from Maxim in about 6-8 weeks.
- Is FluMist® covered?
Yes, in addition to the seasonal flu shot, FluMist® is available to Plan members at no charge. FluMist® is only appropriate for healthy members ages 2-49 years of age. FluMist® is not available in Maxim worksite clinics, but it is available at most doctor's offices and in-network pharmacists. Please note pharmacists can only provide the flu vaccine (shot or nasal spray) to members ages 14 and older.
- 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.
- How do North Carolina state agencies, schools, community colleges and universities sign up for a flu shot clinic?
Health Benefits Representatives or Human Resources departments at state agencies, schools, community colleges and universities interested in hosting a worksite flu shot clinic should contact BCBSNC.
- How will the State Health Plan communicate the flu shot program to North Carolina state agencies, schools, community colleges and universities, retirees and other State Health Plan members?
In August, the Plan will send materials to Health Benefits Representatives and state agencies, schools, community colleges and universities to invite them to host flu shot clinics at their worksites. Beginning in September, members can access information about the flu shot program at www.shpnc.org. Doctor's offices may also promote flu shot clinics in their offices.
- What if I have more questions?
You can visit www.shpnc.org for more information or call State Health Plan Customer Service at 1-888-234-2416.
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.2 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: 2
- 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?
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 receiving the vaccine?
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.2
1 Each 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 with children ages 4-17 and give written authorization (children under 4 should see their doctor). The flu shot 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 administered to high-risk groups before the general public, Maxim will give priority to those who fit the CDC's high-risk standards.
2 "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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