Horizon BCBSNJ In-State Immunization Network Q&As

Please read the following questions and answers to learn more about Horizon Blue Cross Blue Shield of New Jersey’s in-state immunization network.

Q1. Can Horizon BCBSNJ members use any pharmacy in the United States?

A1. To receive the highest level of benefits, members are required to use in-state pharmacies in New Jersey that are contracted as participating ancillary providers with Horizon BCBSNJ. The pharmacies that are contracted in New Jersey to administer immunizations are: ACME, CVS, Kmart, Park Plaza Pharmacy, QuickChek, Rite Aid, ShopRite, Walgreens and Wickapecko Pharmacy.

Q2. How much will members pay if they use a contracted pharmacy?

A2. The member cost share is determined by the immunization benefit on the member’s medical plan. In most cases, it is covered at 100 percent in accordance with Affordable Care Act (ACA) requirements.

If a member has a medical plan with out-of-network benefits and receives a vaccination from a pharmacy that does not participate as an ancillary provider with Horizon BCBSNJ, the member will pay more. The member can submit an out-of-network medical claim form to Horizon BCBSNJ seeking reimbursement for the expense. Claim forms are available at HorizonBlue.com/forms.

Q3. What about members who do not live in New Jersey?

A3. Pharmacies located outside of New Jersey are not contracted with Horizon BCBSNJ’s medical network. Members living outside of New Jersey may receive immunizations from their in-network doctors, a MinuteClinic® located inside select CVS locations, or a HealthCare Clinic located inside select Walgreens locations.

Q4. Who can get immunized through the Horizon BCBSNJ’s in-state immunization network?

A4. New Jersey state law allows pharmacists to be trained and certified to administer flu shots to people ages 7 years and older. In compliance with New Jersey state law, children under age 18 years must obtain parental consent, and pharmacists may give flu shots to children ages 7 to 11 years old who have a prescription from an authorized prescriber.

For immunizations other than flu, a prescription may be needed. Members are advised to consult with their doctors about which immunizations are right for them and whether a prescription is required.

Q5. Which vaccines are covered at these pharmacies?

A5. Standard three-strain (trivalent), standard four-strain (quadrivalent) and high-dose are the common vaccines covered as flu shots. FluMist, a child-friendly nasal spray vaccine, has gained approval from the Centers for Diseases Control and Prevention (CDC) to be available as an option for the 2018-2019 flu season, too. Members are advised to speak with their doctors about which flu immunization is right for them.

Other common vaccines include shingles, hepatitis A and B, pneumococcal, human papillomavirus (HPV), tetanus and measles-mumps-rubella (MMR). Members may wish to check with the pharmacy to be sure which vaccines are available at a pharmacy location and whether a prescription is needed.

State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) members: Out-of network immunizations are only covered for child dependents under age 12 months during a well-child visit if the plan includes out-of-network benefits.

Q6. Does Horizon BCBSNJ sponsor flu clinics or immunization clinics for groups through these pharmacies?

A6. While Horizon BCBSNJ does not sponsor flu clinics, two pharmacies – Rite Aid and Walgreens – are contractually permitted to perform no-cost flu clinics for Horizon BCBSNJ medical members at employer group locations in New Jersey. It is the employer group’s responsibility to contact the local New Jersey Rite Aid or Walgreens for availability and to coordinate dates, times and logistics. The pharmacy will need to have at least two weeks’ notice for an on-site clinic.

Horizon Wellness offers separate in- and out-of-state flu clinic programs for group customers. Please contact your account manager for details.

Published on: September 5, 2018, 08:03 AM ET
Last updated on: September 5, 2018, 08:17 AM ET