It’s not too late to protect you and your family from the flu this winter. The Centers for Disease Control (CDC) recommends that everyone who can tolerate the shot should be inoculated. Your insurance coverage for vaccine varies depending on your plan and the circumstances. It’s important that you follow the insurance plan’s guidelines or you could end up paying for your shots.
Flu immunization is part of the Capital BlueCross Schedule of Preventive Care Services, and is covered through the Lehigh University Comprehensive, PPO, and KeystoneHMO medical benefit plans.
In order to receive in-network coverage for this service, members need to obtain the vaccine from an in-network medical provider, including an outpatient hospital provider, doctor’s office, or retail health center. (Retail health centers can be located by calling customer service, or searching for them at the Capital Blue Cross web site.)
Families covered under the Comprehensive or PPO plans can also receive the flu vaccine at a pharmacy. Be aware, though, that pharmacies are considered out-of-network providers for flu shots. If you choose to use a pharmacy for your flu shots, you will need to pay at the time of service and submit a claim for reimbursement consideration. Coverage for flu shots received at a pharmacy is subject to out-of-network benefits, if available.
Flu shot coverage also varies depending on the recipient’s age (Pediatric: age 6 months through 20 years; Adult: age 21 and over), and the provider of service. Below is an outline of coverage by each of Lehigh’s four plans:
| Plan | Age of Vaccine Recipient | In-Network Medical Provider | Pharmacy or Out-of-Network Provider |
| PPO80 or PPO100 | Pediatric | Waived deductible, pays at 100% of allowed amount | Subject to out-of-network deductible and co-insurance |
| PPO80 or PPO100 | Adult | Waived deductible, pays at 100% of allowed amount | Not Covered |
| Comprehensive | Pediatric and Adult | Waived deductible, pays at 100% of allowed amount | Subject to plan deductible and co-insurance |
| Keystone Health Plan Central HMO |
Pediatric and Adult | Waived deductible, pays at 100% of allowed amount with PCP or with referral to an HMO provider |
Not Covered |
For More Information
If you have any questions about your coverage, call Capital BlueCross Customer Service at 1-800-216-9741, or visit the Member page on the Capital BlueCross website.