Friday, December 11, 2020
DMHC Reminds Californians Approved COVID-19 Vaccines Will Be Provided at No Cost
Directs Health Plans to Cover COVID-19 Vaccines with No Cost-Sharing to Enrollees
The California Department of Managed Health Care (DMHC) issued guidance reminding health plans that all qualified, approved COVID-19 vaccines must be provided with no cost-sharing for health plan enrollees, regardless of whether the enrollee receives the vaccine from an in-network or out-of-network provider.
“As we begin to enter this new phase of the pandemic with vaccines becoming available, the DMHC is reminding health plans they must cover the cost of COVID-19 vaccines,” said DMHC Director Mary Watanabe. “It is critical that all Californians have access to a safe COVID-19 vaccine to help protect their health. Financial challenges should not and will not get in the way of getting protection from COVID-19.”
The DMHC issued an All Plan Letter to health plans regulated by the Department requiring full-service health plans cover qualifying vaccines to prevent COVID-19. In compliance with the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act, health plans must cover the administration costs without any enrollee cost-sharing, such as co-pays, co-insurance or deductibles. Additionally, health plans must cover the costs of administering COVID-19 vaccines to health plan enrollees regardless of whether the vaccines are administered by in-network or out-of-network providers during the federally declared COVID-19 public health emergency.
If a health plan enrollee receives a bill related to the coverage or administration of a qualifying COVID-19 vaccine, they should first file a grievance with their health plan and include a copy of the bill. Their health plan will review the grievance and should ensure the enrollee is reimbursed. If the enrollee does not agree with their health plan's response or if the plan takes more than 30 days to fix the problem, they should file a complaint with the DMHC Help Center at www.HealthHelp.ca.gov or 1-888-466-2219.
The California Department of Public Health has developed guidelines for COVID-19 vaccination describing how California will operationalize its COVID-19 vaccination program. As part of that plan, the state is adopting the three-phased approach to vaccination developed by the federal Centers for Disease Control and Prevention (CDC). In Phase 1, when vaccine supply is expected to be limited, California will focus its efforts on vaccinating its critical populations, including health care personnel, people at increased risk for severe illness or death, and other essential workers. In Phases 2 to 3, as vaccine supply increases, vaccines will become available to a larger portion of the population.
More Information:
DMHC consumer fact sheet reminding Californians approved COVID-19 vaccines will be provided at no cost.
Vaccine Information on COVID19.CA.GOV
Centers for Medicare & Medicaid Services (CMS) guidance on coverage and reimbursement for the administration of the vaccine (Updated link on 9/21/22)
About DMHC:
The DMHC protects the health care rights of more than 26 million Californians and ensures a stable health care delivery system. The DMHC Help Center has assisted approximately 2.4 million Californians to resolve complaints and issues with their health plan. The DMHC Help Center provides assistance in all languages and all services are free. For more information visit www.HealthHelp.ca.gov or call 1-888-466-2219.