The COVID-19 vaccine toolkit, issued by the Centers for Medicare & Medicaid Services, has been updated and now includes a list of vaccines and boosters that are required to be covered without cost-sharing. This chronological list contains COVID-19 vaccines and boosters approved and authorized by the Food and Drug Administration (FDA) in the United States.
Moving forward, non-grandfathered plans must cover authorized vaccines under an Emergency Use Authorization (EUA) or approved vaccines under a Biologics License Application (BLA) without cost-sharing. Meanwhile, grandfathered plans have the ability to choose whether or not to cover the vaccine. However, under certain state laws or applicable insurance policies, these plans may be required to cover the vaccine.
It is important to remember that recommended immunizations are included in preventative care services. During the COVID-19 public health emergency, coverage must be provided for both in- and out-of-network providers.
The Toolkit
The CMS COVID-19 vaccine toolkit was created to assist health insurance issuers in supplying proper coverage and reimbursement for COVID-19 vaccine administration. The toolkit provides a list of operational considerations along with instructions regarding how issuers can communicate with enrollees and providers on vaccines and coverage. It also outlines recent legislative and regulatory provisions surrounding vaccine coverage and administration. Lastly, it recommends issuers implement streamlined processes for more timely administration of vaccine coverage.
If you have any questions regarding the coverage of the COVID-19 vaccines, please reach out to your dedicated Creative Benefits, Inc. team member.