Stick It to the Flu - State Health Plan FAQs

Q: Where can I get a flu shot?

A: North Carolina State Health Plan (SHP) members, including retirees, can receive a flu shot at no charge, while vaccine supplies last, at any of the following locations:

• Physician's office — SHP members may either schedule an appointment for a flu shot or visit a physician’s flu shot clinic. If you go to your doctor’s office and get the flu vaccine from a nurse, there won’t be a charge for the flu vaccine. However, if your physician administers the flu shot or if you receive other services in addition to the flu shot, you’ll be responsible for any applicable copayment, coinsurance or deductible amounts.

• Worksite clinic ¹ — Some SHP 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.

• Participating immunizing pharmacists — Available in limited locations, SHP members may go to a participating pharmacist or CVS MinuteClinic to receive a flu shot. In-network pharmacists have contracted with BCBSNC to administer vaccines covered by the State Health Plan, such as the flu shot. Only SHP members ages 14 and older may receive flu vaccinations from pharmacists. To find a participating pharmacist, visit the Doctors, Rx and Hospitals section of our site and search for "Pharmacist (Flu & Other Limited Injections)” under Specialty. To find a participating CVS MinuteClinic, search for “Convenience Care Center” under Specialty.

Q: How do I get a flu shot at no charge?

A: Members ages 18 and older must present their State Health Plan member ID card in order to receive 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 9 to 17 must be accompanied by a parent or guardian. Dependent children under the age of 9 must see their pediatrician or physician to get a flu shot administered in a child's dose.

Q: When can I get a flu shot?

A: Contact your physician or Health Benefit Representative to find out when flu shots will be administered and to schedule an appointment.

Q: Why aren’t all pharmacists able to provide covered flu shots?

A: Pharmacists in the BCBSNC network are licensed pharmacists who are certified to provide and administer vaccines, such as the flu shot, in a retail pharmacy. In order for a vaccine received in a pharmacy to be covered, only vaccines administered by pharmacists participating in BCBSNC’s networks are eligible for coverage. Pharmacists will only administer flu shots to eligible members¹ ages 14 and older. To find participating pharmacists, visit the Doctors, Rx and Hospitals section on our site, and search for “Pharmacist (Flu & Other Limited Injections)” under Specialty.

Q: Will my flu shot be covered if I go to an out-of-network provider?

A: No. All vaccines, including the flu shot, are only covered when given by an in-network provider. Therefore, if you go to an out-of-network provider for your flu shot, the service will not be covered and you will be responsible for all charges.

Q: 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?

A: SHP members can receive a flu shot at no charge, while vaccine supplies last, at any of the following locations:

• Physician’s office — SHP members may either schedule an appointment for a flu shot or visit a physician’s flu shot clinic. If you go to your doctor’s office and get the flu vaccine from a nurse, there won’t be a charge for the flu vaccine. However, if your physician administers the flu shot or if you receive other services in addition to the flu shot, you’ll be responsible for any applicable copayment, coinsurance or deductible amounts.
• Participating pharmacists — Available in limited locations, SHP members may go to a participating pharmacist or CVS MinuteClinic to receive a flu shot. In-network pharmacists have contracted with BCBSNC to administer vaccines covered by the State Health Plan, such as the flu shot. Only SHP members ages 14 and older may receive flu vaccinations from pharmacists. To find participating pharmacists, visit the Doctors, Rx and Hospitals section of our site and search for "Pharmacist (Flu & Other Limited Injections)” under Specialty. To find participating CVS MinuteClinics, search for “Convenience Care Center” under Specialty.

Q: Is there a list of State Health Plan flu shot clinics?

A: Yes. SHP 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 SHP flu shot clinics. SHP members can also get a flu shot at their doctor's office or, in limited locations, in a CVS MinuteClinic or by a participating, immunizing pharmacist. Only SHP members ages 14 and older may receive flu vaccinations from immunizing pharmacists. To find participating CVS MinuteClinics, visit the Doctors, Rx and Hospitals section of our site and search for "Convenience Care Center" under Specialty. To find participating pharmacists search for "Pharmacist (Flu & Other Limited Injections)" under Specialty.

Q: What about members living outside North Carolina?

A: If a member goes to an in-network provider in their state, the flu shot will be covered.

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

A: Under the North Carolina State Health Plan program, flu shot benefits are limited to members. Nonmembers can receive a flu shot at public health departments. The cost varies and may be covered by private insurance or Medicare.

Q: Who administers the flu shot?

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

Q: Is FluMist^® covered?

A: Yes, in addition to the seasonal flu shot, FluMist® is available to SHP 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 physician'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.

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 Healthcare Services will only administer flu shots to children ages 9-17 who are accompanied by a parent or guardian. Pharmacists will only administer flu shots to individuals ages 14 and older.

Q: How do North Carolina state agencies, schools, community colleges and universities sign up for a flu shot clinic?

A: Health Benefits Representatives or Human Resources department at state agencies, schools, community colleges and universities interested in hosting a worksite flu shot clinic should contact BCBSNC.

Q: How will the State Health Plan communicate the flu shot initiative to North Carolina state agencies, schools, community colleges and universities, retirees and other State Health Plan members?

A: In August, the State Health Plan sent 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. Physicians' offices may also promote flu shot clinics in their offices.

Q: What if I have more questions?

A: You can visit www.shpnc.org for more information or call State Health Plan Customer Service at 1-888-234-2416.