2015-2016 Seasonal Flu Facts for Practitioners

As the primary source of medical information for our members, we encourage you to counsel patients on the importance of getting the flu vaccine and to allay any fears or concerns they might have about the vaccine. Also, discuss the pneumonia vaccination with patients as appropriate.

To help you get the information you need this flu season, listed below are several sources that you may reference:

CDC Recommendations for the 2015-2016 Flu Season

According to the Centers for Disease Control and Prevention (CDC), all people six months of age and older should be vaccinated for the flu with either LAIV or IIV, with no preference expressed when either vaccine is available1. The CDC also notes that the vaccination is especially important for people at higher risk of severe influenza and their close contacts, including health care personnel, close contacts of children younger than six months, pregnant women, people that are 65 years or older and those with certain chronic diseases such as asthma, diabetes and heart disease.

Coverage for Flu Vaccines and Medications

When one of our members visits your office only to get a flu vaccine, there is no copayment, deductible or coinsurance. If the visit is for any other reason and the member also receives a flu vaccine, the regular copayment, deductible and coinsurance applies.

Our members with a combined medical and pharmacy benefit are also covered for influenza antiviral medications as provided for in the Certificate of Coverage or contract.

Approved Locations for Free Flu Vaccinations

We’ve encouraged our members to call their doctor to get the flu vaccine. If your office has the capability this season, please view any visit as an opportunity to vaccinate against the flu. If you are not providing vaccines, please tell your patients they can get a flu vaccine at a network pharmacy, provided that their benefit allows coverage.

EmblemHealth contracts with Express Scripts to provide flu vaccines at network pharmacies. To find a location nearby, have your patients visit emblemhealth.com/pharmacy and click on the “Find a Pharmacy” link. They can also call the phone number listed on the back of their member ID card or our Flu Information Hotline at 1-877-859-9001.

NOTE: Medicaid and Child Health Plus members under the age of 19 must see their doctor to get a free vaccine and are not covered for a free vaccine at any other location.

Obtaining and Reporting Vaccines for Children Under 19 Years of Age

As in years past, the seasonal flu vaccine can be obtained through established office practices. Children under the age of 19 who are uninsured, underinsured, Native American or are enrolled in Medicaid Managed Care or Child Health Plus are covered by the Vaccines for Children (VFC) program and will not be reimbursed by the plan. Physicians who care for these populations may obtain vaccines through the VFC program.

There are reporting requirements for health care professionals administering vaccines to children under the age of 19. Requirements differ depending on where you are located:

Within New York City, vaccines administered to children under the age of 19 must be reported to the New York City Department of Health and Mental Hygiene’s Citywide Immunization Registry (CIR), as per New York City Health Code §11.07. Call 1-212-676-2323 or visit the CIR website for more information about the registry and how to report.

Outside of New York City, vaccinations must be reported to the New York State Immunization Information System.

Want more information? Visit the CDC’s website for information on this season’s flu vaccine. Your county or the NY State Department of Health can also help you learn more.

1 http://www.cdc.gov/flu/about/qa/nasalspray.htm