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Changes to State Immunization Program

 Childhood Vaccines Will be Paid for Differently as of Jan. 1, 2008

new smaller logoStarting January 1, 2008, children’s vaccines will be paid for in a different way.
In the past, the federal government provided vaccines at no charge for every child in the state. But starting January 1, because the number of recommended vaccinations has increased and the federal vaccine allotment has not, insurers will be billed for vaccines.

This means North Dakotans may begin to see – for the first time – deductibles, copayments and/or coinsurance for vaccinations on their explanation of benefit (EOB) reports from their insurers. Cost sharing amounts may vary depending on the insurance plan.

If your employer offers a flexible benefits plan, you may want to adjust your plan to include any out-of-pocket medical expenses that may not be covered by insurance. Check your benefit plan booklet for vaccination coverage as you prepare for enrollment in your 2008 flexible benefits.

Many health insurance plans cover immunizations; however, there are many variations from one health plan to another. Thus it is always advisable for members to contact their insurer to ask what is or is not covered in their health benefit plan.

If your insurance policy does not cover vaccines – or if your child is uninsured, Native American or eligible for Medicaid – please talk to your health-care provider. Your child may be eligible to receive free vaccines through the federal Vaccines For Children program.

Check your insurance plan’s vaccination coverage
To find out if your insurance company covers vaccines, check your benefit booklet or call your insurance company and ask the following questions:

• Do I have insurance that covers immunizations?
• Does my insurance cover these immunizations recommended by the Advisory Committee on Immunization Practices or the Centers for Disease Control and Prevention?
     • Diphtheria, tetanus and pertussis (DTaP or Tdap)
     • Haemophilus influenza type B (Hib)
     • Hepatitis B (Hep B)
     • Polio (IPV)
     • Rotavirus (RV or Rota)
     • Pneumococcal (PCV7)
     • Measles, mumps, and rubella (MMR)
     • Hepatitis A (Hep A)
     • Influenza (Flu)
     • Intranasal influenza vaccine (Flumist, LAIV or CAIV)
     • Meningococcal (MCV4)
     • Human papillomavirus vaccine (HPV)
     • Varicella (chickenpox)
• Are there any coverage limitations or restrictions, such as age limitations on covered vaccines  restrictions on travel vaccinations?
    • What are they?
    • How do they apply?
• Will I have to pay anything for immunizations?
    • Copay or coinsurance
    • Deductibles
• Is there a maximum amount my insurance will cover each year for wellness services, preventive services or immunizations?

One of the most important things parents can do to protect their children is to make sure they are vaccinated against serious but preventable diseases. More information about immunizations is available on the North Dakota Department of Health web site at www.ndhealth.gov.