COVID-19 Vaccines and Coverage

In the face of the COVID-19 pandemic, pharmaceutical companies have moved to produce vaccines. The Food and Drug Administration (FDA) awarded an Emergency Use Authorization (EUA) to two companies for their vaccines: Pfizer on Dec. 11, 2020, and Moderna on Dec. 18, 2020.

Federal and state health officials are working with the medical community to distribute the COVID-19 vaccine.

Rollout Projections: The federal government is working with drug companies to have 300 million doses  by the end of January 2021. Health care workers and long-term care facility residents have priority access. The Centers for Disease Control and Prevention (CDC) projected rollout is below:

Initially, the federal government will pay for the vaccine. Blue Cross and Blue Shield of Oklahoma (BCBSOK), or self-funded groups, will cover administration of the vaccine as noted below:

Fully insured:

• Vaccine and administration covered as a preventive service with no cost-share to members at in-network providers
• Vaccine and administration covered with no cost-share to members if delivered at out-of-network providers through the end of the public health emergency

Self-funded employer groups:

• Non-grandfathered self-funded employer groups - vaccine and administration covered as a preventive service with no cost-share to members at in-network providers
• Vaccine and administration covered at no cost-share to members at out-of-network providers through the end of the public health emergency
• Self-funded employer groups that don't cover preventive vaccines through their pharmacy benefit must cover the vaccine through their medical benefit
• Grandfathered plans are not required to cover preventive services, including the COVID-19 vaccine

Medicare Advantage and Medicare Supplement

• For 2020 and 2021, Medicare payment for the COVID-19 vaccine and its administration will be through the original fee-for-service Medicare program.
• Submit claims for administering the COVID-19 vaccine to the CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved.
• Members will have no cost-sharing on vaccines through Dec. 31, 2021.

Reimbursement:

• In-network providers will be reimbursed for the administration fee based on contracted rates.
• Out-of-network providers will be reimbursed based on established OON reimbursement policy that follows Medicare rates.

Balance billing: Providers are prohibited from billing patients for the vaccine or its administration, including balance billing, if the provider received the vaccine at no cost from the government.

Coding claims: CMS and the American Medical Association (AMA) have identified the codes to use in submitting claims. For more information, see CMS' guidance .

Dosage: Candidate vaccines may require one or two doses. The Pfizer and Moderna vaccines require two doses.

More information:

• CDC COVID-19 Vaccination Program Interim Playbook  for Jurisdiction Operations
• Provider Relief Fund – for reimbursement for administering the COVID-19 vaccine to the uninsured
• CMS guidance  on Medicare billing for the COVid-19 vaccine administration

We continue to monitor information provided by the CDC and other government and health officials. We'll provide updates when we have them. For the latest information on COVID-19, we recommend visiting the CDC's COVID-19 website .

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