If the vaccine is administered in the U.S. and your GeoBlue plan covers preventive treatment in the U.S.
The cost of the COVID-19 vaccine is covered by the U.S. government under the CARES Act regardless of whether or not your policy includes an immunization/vaccination benefit. The pharmacy or provider, where you have the vaccine administered, will be reimbursed under the CARES Act. You are not responsible for any cost share for the vaccination itself.
If there is an administration charge in addition to the cost of the vaccine, you will need to check your certificate of insurance or benefit summary to see if your policy includes an immunization or vaccination benefit. If yes, GeoBlue will cover 100% up to the CMS* published fee:
Vaccination(s) administered prior to March 15, 2021: CMS regulated administration fees:
- Single dose vaccine: up to $28.39 for a single dose vaccine;
- Double dose vaccine: up to $45.33 ($16.94 + $28.39 for both doses).
Vaccination(s) administered on or after March 15, 2021: CMS regulated administration fees:
- Single dose vaccine: up to $40;
- Double dose vaccine: up to $40 per dose
If your plan does not include an immunization/vaccination benefit, then you are responsible for any administration costs charged separate from the cost of the vaccine.
If the vaccine is administered outside the U.S.
You should check your certificate of insurance or benefit summary to determine if your policy includes coverage for immunizations or vaccinations. Based on the country where the vaccination is administered, the government may or may not fund the cost. GeoBlue will not reimburse any claims for the cost of the vaccination in locations where the government funds the cost. GeoBlue will pay eligible non-government paid vaccination costs based on reasonable charges based on your plan immunization/vaccination benefit (member cost share and limits may apply). Additionally, if the administration fee is a separate charge, GeoBlue will pay that fee at 100% using the CMS* fee as the maximum amount:
Vaccination(s) administered prior to March 15, 2021: CMS regulated administration fees:
- Single dose vaccine: up to $28.39 for a single dose vaccine;
- Double dose vaccine: or up to $45.33 ($16.94 + $28.39 for both doses).
Vaccination(s) administered on or after March 15, 2021: CMS regulated administration fees:
- Single dose vaccine: up to $40;
- Double dose vaccine: up to $40 per dose
The COVID-19 vaccine and any associated fee(s) are NOT covered on policies that do not have an immunization or vaccination benefit.
*The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS) in the US. GeoBlue will consider administration fees for the COVID-19 vaccine based on reasonable cost using CMS published fees when the plan includes an immunization/vaccination benefit.