Immunization Benefits – Medical Pharmacy

HMSA will only cover immunizations administered to HMSA members, age 18 or older, by a pharmacist with the appropriate training.

Members Age 5 or Younger

All HMSA plans cover standard childhood immunizations for members age 5 or younger at 100 percent of the eligible charge.

Preferred Provider Plans

HMSA’s Preferred Provider Plans cover standard immunizations at 100 percent of eligible charge. In general, deductibles are not applied to immunizations supplied and administered by participating providers. However, as an exception, specific coverage codes such as coverage code 452 apply the annual deductible to immunizations.

Do not charge Preferred Provider Plan members in full at the time of service, except in situations when a deductible has been applied. However, you may charge the member the applicable copayment.

HMO Plans

Immunizations are covered for members of Health Plan Hawaii and HMSA’s other HMO Plans. No copayments are applied to immunizations. The plans do not have deductibles.

Do not charge HMO members in full at the time of service.

Tax

Tax should not be billed for vaccines. However, if the pharmacist administers a vaccine, tax may be charged on the administration fee.

Tax is not a benefit of the Preferred Provider Plan and may be charged to the member. (As an exception, payment made by HMSA’s Federal Plan, coverage code 087, includes payment on the tax charge.)

For HMO plans, HMSA’s payment includes the tax and the member should not be charged.

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