Q: Now that the COVID-19 vaccines have been approved, how will health insurers and self-insured plans cover the vaccine and what will the cost be to the health plan?

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A: The CARES act requires that non-grandfathered group health plans and health insurance offerings provide the vaccine without cost sharing for both in-network and out-of-network providers during the COVID-19 public health emergency.

During the initial phase of limited vaccine supply, the federal government will purchase the supply and allocate vaccines to the states for prioritized distribution. During this time, the federal government will be covering the ingredient cost of the COVID-19 vaccine. Health Plans will pay any additional cost outside of the ingredient. Non-grandfathered group health plans will be required to cover the administration cost with zero cost share to members. Under the agreement, all providers must vaccinate individuals regardless of whether they have health insurance coverage or what type of coverage they have and are prohibited from balance billing or otherwise charging vaccine recipients.

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