Stick it to the Flu® - State Health Plan FAQs

Questions about the Flu Shot Program

Where can I get a flu shot at no charge?

North Carolina State Health Plan (Plan) members, including retirees enrolled in the 80/20 Plan, Consumer-Directed Health Plan and the 70/30 Plan, can get a flu shot at:

  • The Doctor's office — Plan members can either make an appointment for a flu shot or go during a doctor's scheduled flu shot clinic. If you go to your doctor's office and get the flu shot from a nurse, there won't be a fee. But, if the doctor gives you the flu shot or if you get other medical care in the same visit, you'll have to pay a fee (e.g., copay, coinsurance or deductible fees).
  • Worksite clinic 1 Some Plan members can get a flu shot where they work. Retired Plan members may be able to get a flu shot at their former workplace. Members must be over 18 to get a flu shot at a worksite clinic. Members should ask their Health Benefit Representative to find out if their workplace is having a flu shot clinic. Members can also see a list of all worksite flu clinics on www.shpnc.org.
  • An in-network immunizing pharmacist or convenience care center — Available in a few locations. Plan members ages 14 and older can go to an in-network immunizing pharmacist for a flu shot. To search for in-network immunizing pharmacists visit Find a doctor and enter your ZIP code. Type "Pharmacist" into the search box and under Specialties, select "Pharmacist (Flu & Other Limited Injections) - Convenience Care (Facilities)".
 
When can I get a flu shot?

Members can ask their doctor, employer, or pharmacist to find out when flu shots will be given and to make an appointment.

Why can't all pharmacists give flu shots?

In order for the shot to be covered, it must be given by an immunizing pharmacist in the Blue Cross NC network. They will only give flu shots to 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, you will have to pay a fee.

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, including dependent children, can get a flu shot at no charge at:

  • Doctor's office — Plan members can either make an appointment for a flu shot or go during a doctor's scheduled flu shot clinic. If you go to your doctor's office and get the flu shot from a nurse, there won't be a fee. But, if the doctor gives you the flu shot or if you get other medical care during the same visit, you'll have to pay a fee (copay, coinsurance or deductible fees).
  • An in-network immunizing Pharmacist or convenience care center — Available in a few locations. Plan members age 14 and older can go to an in-network immunizing pharmacist for a flu shot. To search for in-network pharmacists, visit Find a doctor and enter your ZIP code. Type "Pharmacist" into the search box. Under Specialties, select "Pharmacist (Flu & Other Limited Injections) - Convenience Care (Facilities)".
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Is there a list of State Health Plan flu shot clinics?

Yes. Plan members should check with their Health Benefit Representative to see their worksite will have a flu shot clinic. Members can also go to www.shpnc.org for a list of flu shot clinics.

What about members living outside North Carolina?

The flu shot is covered for members who go to an in-network doctor in their state.

My spouse and children are not covered under my plan. Can they get a flu shot too?

Under the Plan, flu shots are covered for members only. Others can get a flu shot at public health departments. There may be a fee and/or it may be covered by private insurance or Medicare.

I didn't have my State Health Plan/Blue Cross NC member ID card at the worksite flu shot clinic and had to pay $35. How do I get that money back?

If you do not bring your State Health Plan/Blue Cross NC member ID card and a photo ID to your worksite flu shot clinic, then they can't check if your flu shot should be covered. This means you will have to pay $35 for your flu shot. You will be given a receipt for your payment.

To ask for your money back, e-mail bcbsnc@maxhealth.com your ID number, two-digit dependent number, and group number (if applicable) from your Blue Cross NC ID card. Also give the date and place of the flu shot clinic you went to. You should get a check in the mail in about 6-8 weeks.

Is FluMist® covered?

Yes but the Centers for Disease Control and Preventive (CDC) recommends FluMist® not be used for the 2017-2018 flu season. FluMist has been shown to be less effective at preventing the flu.

What about the flu shot for children?

Children under the age of 18 can get a flu shot at a doctor's office. Members ages 14 and older can get the flu shot from an immunizing pharmacist.

How do North Carolina state agencies, schools, community colleges and universities sign up to have a flu shot clinic?

Health Benefits Representatives or Human Resources departments at state agencies, schools, community colleges and universities interested in having a worksite flu shot clinic should sign up for a flu shot clinic here.

How will North Carolina state agencies, schools, community colleges and universities, retirees and other State Health Plan members learn about the flu shot program?

In August, the Plan will invite Health Benefits Representatives and state agencies, schools, community colleges and universities to sign up to have flu shot clinics at their worksites. Beginning in September, members can learn about the flu shot program at www.shpnc.org.

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 Flu Shot

Who should get the flu shot?

The Centers for Disease Control and Prevention (CDC) says that everyone over the age of 6 months should get a flu shot every year.2 The flu, also known as influenza, spreads quickly through the air from person to person. You can also get the flu from people who have come in contact with it, but haven't shown any symptoms. This means that you can be contagious and not even know it.

While everyone should get a flu shot each year, it's even more important that certain people get the shot because they may get more sick from the flu than most people. Those people are 2

  • Children younger than five, but especially children younger than two
  • Women during pregnancy and 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 medical conditions (ask your doctor)
  • People who are 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. Those people are:

  • Anyone with a severe allergy to chicken eggs
  • People who've had a severe reaction to a flu shot in the past
  • People who have developed Guillain-Barré syndrome within six weeks of getting a flu shot
  • 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 cannot infect you. 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.

How well does the flu shot work?

How well the flu shot works depends on three things:

  • The person's age
  • The person's health
  • Whether or not the vaccine is a "match" to the flu virus currently in the community.

While getting a flu shot doesn't mean you won't get the flu, it can protect you from getting severe symptoms and complications. It takes about two weeks for the flu shot to start working. During that 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 possible 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.

Severe allergic reactions to the shot are rare. Anyone who is allergic to chicken eggs should not get the flu shot since the virus used in the shot is grown in eggs. If you have any problems after getting 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. Participants must be 18+. 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 August 2017)

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