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HSA Plan

Network

100% coverage when administered by a network provider or pharmacy

Non-Network

Up to $25 reimbursement

PPO 750 Plan

Network

100% coverage when administered by a network provider or pharmacy

Non-Network

Up to $25 reimbursement

PPO 1250 Plan

Network

100% coverage when administered by a network provider or pharmacy

Non-Network

Up to $25 reimbursement

The seasonal flu vaccine is covered under the preventive care benefit at 100% when administered by a network provider or pharmacy, including Express Scripts, Inc. (ESI) network pharmacies.

When the flu vaccine is obtained from a non-network provider or pharmacy, the member must submit a receipt and a Vaccine Reimbursement (Non-network) form to their medical plan to receive reimbursement.

Flu vaccinations are covered as recommended by the Advisory Committee for Immunization Practices (ACIP) of the Centers for Disease Control and Prevention.


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