Flu shots and your benefits
How much does a flu shot cost?
Most members can get their flu shot at no extra cost. This is because it’s part of the preventive care benefits required by the Affordable Care Act.
Some Blue Shield plans have low out-of-pocket costs for the flu shot. These include:
- Some grandfathered plans. Grandfathered plans may have a copay for flu shots. You may also need to visit a medical office, rather than a pharmacy, for your shot to be covered. You have a grandfathered plan if the plan name at the bottom of your card ends with a “G.” If you’ve had your plan since before March 23, 2010, you may have a grandfathered plan.
- Some self-funded or administrative services only (ASO) plans. Some of these plans come with a copay or coinsurance for immunizations. Not sure if you have an ASO plan? Check your member ID card. You have an ASO plan if it has “administrative services only” printed on the back bottom corner.
How can I find out if I have a cost for the flu shot?
To view preventive care benefits, you can:
- Log in to your member dashboard and click “Benefits” under the “myblueshield” tab.
- Check your Evidence of Coverage (EOC) or Certificate of Insurance.
If you are still not sure if you have out-of-pocket costs for flu shots, please call the customer service number on your member ID card.
Where can I get a flu shot?
You can go to your doctor's office or, if your plan includes pharmacy benefits, to an in-network retail pharmacy. If your member ID card contains an “RxPCN” or “RxBIN” number, you have pharmacy benefits. Depending on your plan, other flu shot locations and services may be available to you. Visit our locations page to find a location near you.
- Some locations may not have access to all the types of flu vaccines.
- Some pharmacy locations may have age restrictions.
Contact the location before you go to find out if they have a specific kind of flu shot that you might need or if they have any age restrictions.
How do I know if my plan includes pharmacy benefits?
Check your Blue Shield of California or Blue Shield of California Promise Health Plan member ID card for a “RxPCN” or “RxBIN” number. If you see either of these, then your medical plan includes pharmacy benefits.
If this information is not on your medical member ID card, you may have pharmacy benefits through another company or pharmacy benefit manager (PBM). Please check with your employer or human resources department.
I have a standalone Medicare Prescription Drug Plan. Will my flu shot be covered by Blue Shield?
If you have this type of plan, please visit your doctor to get your flu shot. Your shot will be covered by your medical benefits, not your pharmacy benefits with Blue Shield.