BLUE VISION^SM

Sept. 29, 2023

COVID-19 Vaccines Update
Applies to non-grandfathered group plans

Blue Cross and Blue Shield of Illinois (BCBSIL) plans to cover the latest COVID-19 vaccines as part of our Affordable Care Act (ACA) Preventive Services policy. This coverage aligns with recent announcements by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).

• BCBSIL will continue to cover all FDA-authorized COVID-19 vaccines without cost sharing when obtained at an in-network doctor’s office or participating in-network pharmacy.
• This includes the recently approved versions of the vaccines.

• The vaccines are covered without cost sharing whether the member is getting their first shot or a booster.

• Illinois HMO members must get the vaccines from an in-network provider (not a pharmacy), as they do for any other preventive vaccine.

• Groups with a pharmacy benefit manager (PBM) other than Prime Therapeutics® should check with their PBM to confirm coverage.

• As a reminder, coverage of COVID-19 vaccines without cost sharing from an out-of-network provider ended with the Public Health Emergency.

• Coverage of the COVID-19 vaccines follows our standard preventive services policy for vaccines (see below for more details). Going forward, it will continue to be covered without cost sharing like any other preventive vaccine, such as the flu, RSV and others.

When did BCBSIL plans start covering the new vaccines?

BCBSIL plans began covering the new vaccines following the FDA approval and CDC recommendation, which was announced on Sept.12 and loaded into our system Sept. 15 for children and Sept. 18 for adults.

Is there information available for members about the vaccines?

As with any other preventive service, members should check with their provider. Members can also refer to the CDC website  for more details about the newest vaccines and who should get them.

How does BCBSIL determine which vaccines or other preventive services are covered without cost sharing?

Our ACA Preventive Services Workgroup reviews and implements all required recommendations released by the United States Preventive Task Force (USPSTF) with an “A” or “B” rating, the Health Resources & Services Administration (HRSA) for preventive care and screenings for women, the Advisory Committee on Immunization Practices (ACIP) which are adopted by the Director of the CDC, and the American Academy of Pediatrics’ Bright Futures Project which are supported by the HRSA.