December 16, 2020 - California Department of Managed Health Care on COVID-19 Vaccine Costs.
You Have the Right to a COVID-19 Vaccine With NO Out-of-Pocket Cost.
Health plans1 regulated by the DMHC must cover COVID-19 vaccines and the administration costs without any enrollee cost-sharing. Cost-sharing includes co-pays, co-insurance, deductibles or other out-of-pocket costs.
Additionally, health plans must cover the costs of administering COVID-19 vaccines to health plan enrollees regardless of whether the vaccines are administered by in-network or out-of-network providers during the federally declared COVID-19 public health emergency.
What Should You Do if You Are Charged for a COVID-19 Vaccine?
If a health plan enrollee receives a bill related to the coverage or administration of a qualifying COVID-19 vaccine, they should first file a grievance with their health plan and include a copy of the bill. Their health plan will review the grievance and should ensure the enrollee is reimbursed. If the enrollee does not agree with their health plan’s response or if the plan takes more than 30 days to fix the problem, they should file a complaint with the DMHC Help Center at www.HealthHelp.ca.gov or 1-888-466-2219.
When Can You Get a COVID-19 Vaccine?
The California Department of Public Health has developed guidelines for COVID-19 vaccination describing how California will operationalize its COVID-19 vaccination program.
As part of that plan, the state is adopting the three-phased approach to vaccination developed by the federal Centers for Disease Control and Prevention (CDC). In Phase 1, when vaccine supply is expected to be limited, California will focus its efforts on vaccinating its critical populations, including health care personnel, people at increased risk for severe illness or death, and other essential workers. In Phases 2 to 3, as vaccine supply increases, vaccines will become available to a larger portion of the population.
More information about the COVID-19 vaccine and its administration is available at www.covid19.ca.gov/vaccines/.
1 except grandfathered plans
Source: CADMHC
