What Is A Company-Sponsored Flu Clinic?
All Flu clinics are for Seasonal Influenza. The seasonal flu shot vaccine contains vaccination against the H1N1 virus.

Who Is Eligible to Receive The Shot?
Flu shots are a covered benefit for Harvard Pilgrim Health Care (HPHC) members. They are not “free” (covered in full for members who present their HPHC ID card at clinic).

Shots are covered up to their benefit limits. Under Federal Health Care reform, flu vaccines are to be covered in full as preventive for ALL products (unless in an ER or inpatient, or out-of-network).

The participant may receive a bill from Maxim if the participant’s policy carries a cost share for flu shots or if the insurance policy presented is not valid.

Unless specifically told otherwise, shots for all HPHC members, who show their valid HPHC insurance card, will be processed via claims and the expectation will be for non-members to be individually responsible for the $25.00 charge. Participants who do not show a valid HPHC insurance card at the time of the shot are considered Non-HPHC.

Non-HPHC members including HPHC members who do not show their HPHC insurance ID card at the clinic may receive shots at the flu clinic, but payment for such must be decided prior to the submission for the clinic. (Two options: (A) The participant is individually responsible for the $25.00 shot fee at the time of the vaccine. Maxim accepts checks, made payable to “Maxim” as well as cash. Maxim will provide a receipt which can be submitted to their carrier for potential reimbursement. OR, (B) the account can be billed for non-member shots.)

Children 4 years and above can receive the vaccination, provided they have a signed consent from a parent/guardian. The 2nd Flu booster shots indicated for children under age 9 would be deferred to the child’s PCP.

When Are The Flu Clinics Scheduled?
Clinics will run September 16 thru December 31, 2014.

How Much Does It Cost?
Flu shots cost $25.00 each. Each participant must fill out a consent form (provided at the clinic) prior to receiving the shot.

All clinics have a 25 shot minimum per day per location. Accounts holding clinics with less than 25 shots requirement will be responsible for the difference up to the 25 shot minimum. Example: A clinic has 19 participants. The account will be billed for $150.00 (the cost of 6 shots to meet the 25-shot minimum). This applies regardless of the funding method chosen by the account.

Influenza shots provided by HPHC will NOT be reimbursable through Medicare and / or Medicaid. HPHC will not be able to invoice Physician’s Offices.

Other Pertinent Info for Employers
Clinic staff do not have the ability to look up HPHC numbers electronically or on rosters.

As with all of our screenings, we cannot provide employer groups with a detailed list of employees that participate for billing or other inquiries as this violates HIPAA privacy rules.

Please email Denise LaCarubba at denise@hrknowledge.com to arrange to set up a flu clinic.

This content is provided with the understanding that HR Knowledge is not rendering legal advice. While every effort is made to provide current information, the law changes regularly and laws may vary depending on the state or municipality. The material is made available for informational purposes only and is not a substitute for legal advice or your professional judgment. You should review applicable law in your jurisdiction and consult experienced counsel for legal advice. If you have any questions regarding this advisory, please contact HR Knowledge at 508.339.1300 or email us at hr@hrknowledge.com.