Stick It to the Flu - Frequently asked questions

Q: 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 HMO^SM
• Blue Medicare PPO^SM
• Blue Medicare Supplement^SM
• North Carolina State Health Plan
• North Carolina Health Choice for Children
• North Carolina Federal Employee Program

Q: 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

• Physician's office — Some members may pay an office copayment, deductible or coinsurance, depending on their specific benefits. 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.

• Worksite clinic — Many employers have chosen to host worksite flu shot clinics this year, at no cost to the member. Members of a group plan should contact their Human Resources or benefits department for more information

• 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 seasonal 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.

Q: 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.

Q: 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.

Q: 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 Member Guide, contact your plan administrator or call BCBSNC Customer Service at the toll-free number listed on your BCBSNC ID card for more information.¹

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

A: 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.

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

A: 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.

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

A: 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.

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

A: 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.

Q: Who administers the flu shot?

A: 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.

Q: 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?

A: 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 keramalh@maxhealth.com. 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.

Q: Is FluMist^® covered?

A: 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 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.

Q: What about the pediatric flu shot?

A: 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.

Q: What if I have more questions about the seasonal flu vaccine?

A: You can visit our Web site at bcbsnc.com/flu for more information or call BCBSNC Customer Service at the toll-free number listed on your BCBSNC ID card.

Q: Who should get the seasonal flu vaccine?

A: 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

Q: Who shouldn’t get the flu vaccine?

A: 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

Q: Can I get the flu from the vaccine?

A: 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.

Q: Can I still get the flu after receiving the vaccine?

A: 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

Q: Are there any side effects from the flu shot?

A: 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

Q: What are the chances that providers will run out of flu vaccines this year?

A: While there are no guarantees of flu vaccine availability, public health officials have determined that supplies of the vaccine are plentiful for 2009 and early 2010.

Q: What's the 2009 H1N1 flu?

A: It's a new influenza virus that's similar to the seasonal flu. It isn't spread from eating or preparing pork or pork products. ⁵

Q: How's the 2009 H1N1 flu different from seasonal flu?

A: While the symptoms of 2009 H1N1 are very similar to the seasonal flu, most people have little to no immunity to 2009 H1N1, and people younger than 65 appear to be at greater risk.

Q: What are the signs and symptoms of 2009 H1N1 flu?

A: Symptoms may include:

• Fever
• Cough
• Sore throat
• Runny or stuffy nose
• Body aches
• Headache
• Chills
• Fatigue
• Diarrhea
• Vomiting

Warning signs that a person with the flu needs urgent medical attention:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worsening cough

The influenza virus can be unpredictable, and the CDC's recommendations are subject to change.

Q: Does BCBSNC cover the 2009 H1N1 vaccine?

A: Yes. BCBSNC will waive any deductible and coinsurance amounts that may apply for our fully insured members who do not have immunization/preventive benefits and will pay 100 percent of eligible charges for the administration of the H1N1 vaccine. Members in self-funded (ASO) plans should check with their plan administrator to determine if a copayment, deductible or coinsurance will apply for the H1N1 vaccine administration. For the seasonal flu vaccine, a copayment, coinsurance and deductible payments may apply for some members.

Q: Will the seasonal flu vaccine protect against the 2009 H1N1 virus?

A: No. The 2009 seasonal flu vaccine was developed before the detection and outbreak of the 2009 H1N1 virus in April 2009. Protection against the 2009 H1N1 influenza needs a different vaccine. However, getting a seasonal flu shot should still be a high priority, since preventing seasonal flu will decrease the chances of the 2009 H1N1 virus causing more severe illnesses.

Q: How much vaccine is available?

A: The CDC has estimated that supplies will be sufficient to provide coverage to all high-risk individuals first, followed by the lower-risk population.

BCBSNC is working with the North Carolina Department of Public Health and Maxim Healthcare Services, our worksite flu vaccine provider, to ensure that there's enough 2009 H1N1 vaccine for our members.

Q: Do I need to get the 2009 H1N1 vaccine if I've had swine flu?

A: You should still get the H1N1 vaccine, even if you were diagnosed with the 2009 H1N1 flu. In most cases, confirmed H1N1 testing is only conducted in hospitals.

Q: Will a nasal spray version of the 2009 H1N1 vaccine be available?

A: The majority of the vaccine supply will be an injectable, but there's also a nasal spray version being produced. The nasal spray vaccine supply will account for less than 15 percent of the total H1N1 supply.

Q: Where can I get more information on H1N1?

A: To get the most up-to-date information about H1N1, visit the CDC's Web site. Other resources include:

• North Carolina Division of Public Health
• World Health Organization
• Pandemic Flu Preparedness
• Members who have the Health Line Blue^SM benefit may also talk to a nurse 24/7 about possible symptoms. Members with this benefit will see the toll-free "Nurse Support Line" number listed on the back of their BCBSNC ID card.