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HealthPartners

Coverage criteria policies

Immunizations

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Immunizations generally do not require prior authorization from Pharmacy Administration.

Coverage

Immunizations are generally covered per the national Center for Disease Control and Prevention (CDC) guidelines. Additional comments and coverage restrictions are included below:

  1. All types of Influenza (flu) vaccines are covered, as recommended by the CDC.
  2. HPV vaccines (Gardasil and Cervarix) are covered, as recommended by the CDC
  3. Shingles vaccines (Shingrix and Zostavax) are covered, as recommended by the CDC.
  4. Pneumococcal vaccines (Prevnar and Pneumovax 23) are covered, as recommended by the CDC.
  5. Prophylactic immunizations required as a condition of travel, when travel is not associated with employment.

Indications that are not covered

  1. Immunizations for individuals, who by reason of their employment, are involved in activities that place them at high risk for developing a disease deemed preventable by an immunization. In these situations, the employer is responsible for the cost of the immunization.
  2. Immunizations required because of an injury or immediate risk of infection due to the member’s employment. In these situations, the employer is responsible for the cost of the immunization.

Definitions

Influenza vaccine to prevent the “flu” is given by injection with a needle (flu shot) or as an intranasal spray.

HPV vaccine (Gardasil and Cervarix) prevents cervical cancer, precancerous genital lesions, and genital warts due to human papillomavirus virus (HPV), and some other oral and anal cancers caused by HPV.

Shingles vaccine (Shingrix and Zostavax) are used to prevent herpes zoster (shingles).

Pneumococcal vaccines (Prevnar and Pneumovax 23) prevent pneumococcal disease that can cause pneumonia, meningitis, and bloodstream infection.

Prophylactic immunizations refer to vaccines given to prevent symptoms of a disease.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

References

  1. Center for Disease Control and Prevention (CDC): www.cdc.gov/vaccines
  2. Minnesota Department of Health (MDH): www.health.state.mn.us/divs/idepc/immunize

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Policy activity

  • 04/30/1994 - Date of origin
  • 04/01/2018 - Effective date
Review date
  • 11/2017
Revision date
  • 02/05/2018

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