ConnectiCare members are covered for the flu vaccine. For most members, there is no copayment, coinsurance or deductible if the only reason for a visit is to get a flu shot. If there is an additional, separate reason billed for a visit, applicable copayment, coinsurance and deductible will apply.
If a member receives a flu vaccination from a non-participating provider, ConnectiCare will cover the usual-and-customary amount. If a member pays for the immunization out of pocket, he or she can provide a receipt to ConnectiCare along with a completed Out-of-Plan Reimbursement Form. Medicare members should use this Medicare Out-of-Plan Reimbursement Form.
Members may also call us at 1-800-251-7722 (commercial plans) or 1-800-224-2273 (Medicare plans) to request a reimbursement form. TTY service is also available at 1-800-833-8134 (commercial plans) or 1-800-842-9710 (Medicare Plans).
Please note: The Center for Disease Control and Prevention (CDC) has recommended that Flumist not be used for the 2017-18 flu season due to concerns about its effectiveness against influenza A (H1N1) virus in the U.S. As a result, ConnectiCare will not cover Flumist.
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*Code 90756 is not available for payment until after Jan. 1, 2018, per the Centers for Medicare & Medicaid Services guidance. **Code 90749 for commercial and Q2039 for Medicare will only be covered through Dec. 31, 2017. |
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