Is the COVID-19 Vaccination covered under SBMA’s plans?
The cost of the vaccine is covered 100% under all health plans. There is however a cost associated with the administration of the vaccine doses by a pharmacist or other healthcare facility.
SBMA plan designs that include office visits and/or prescription drug coverage will automatically cover vaccination administration costs providing payments directly to the healthcare provider/facility.
Plan designs that do not include those benefits will offer coverage in the form of reimbursements. Members will pay the administrative fees at the time of service and submit copies of their receipts and the COVID-19 Vaccination Record Card along with a completed SBMA COVID-19 Vaccination Claim Form to SBMA for processing. Members will be reimbursed within approximately 60 days from the date of submission.
To download the claim for reimbursement click here: https://www.sbmabenefits.com/wp-content/uploads/2021/01/SBMA-COVID-19-Vaccination-Claim-Form.pdf
How can individuals get the vaccine?
Go to your local pharmacy to receive the vaccine (when available in your area)
What Employers Need to Know:
What vaccines are currently approved?
The Pfizer and Moderna vaccines have both been authorized emergency authorization usage by the FDA they were rolled out in December 2020.
Who gets the vaccine first?
The first round of individuals to receive the vaccine are frontline healthcare workers, long-term care residents, and first responders.
How much will the vaccine cost?
According to the CDC, vaccine doses purchased with U.S taxpayer dollars will be given to the Americans free of charge. However, it’s important that understand that vaccine providers will be able to charge administrative fees for administering shots to individuals.
Can employers make the vaccine mandatory?
Employers will have to navigate religious beliefs and health concerns for some employees in mandating vaccination. In general, an employer can require a vaccination, but there are legal concerns with any mandate and employers should consult their attorney before putting a mandate in place. Please see the EEOC information regarding the laws surrounding the COVID vaccine.
Who can buy the vaccine?
The federal government is the only agency allowed to purchase the COVID-19 vaccine.
COVID-19 testing is limited to FFCRA1 and CDC2 guidelines or due to medical necessity. Testing is also limited to outpatient settings excluding emergency facilities and/or hospitals.
Community testing sites can be found in your are here:
The Centers for Disease Control and Prevention (CDC) advises that doctors should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.
An attending provider means an individual who is licensed under applicable state law, who is acting within the scope of the provider’s license, and who is directly responsible for providing care to a patient. A plan, issuer, hospital, or managed care organization is not an attending provider. Criteria can be found here: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
Community testing sites can be located here: https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html
- Families First Coronavirus Response Act
- Centers for Disease Control and Prevention