As the first Californians begin receiving the COVID-19 vaccination, many of us have a renewed sense of hope and optimism. It’s light at the end of the tunnel we’ve been long waiting to see. At the same time, we realize it also raises many questions about what will happen next. Please take a moment to read the following Frequently Asked Questions.
How soon will members be able to get a COVID-19 vaccine?
Sutter Health Plus recommends that members contact their primary care physician (PCP) to discuss their situation and health risk factors to understand when they can anticipate getting a COVID-19 vaccine.
Will Sutter Health Plus cover COVID-19 vaccines?
Yes. Sutter Health Plus covers COVID-19 vaccines in accordance with the requirements established by the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
Will members be responsible for any cost share associated with COVID-19 vaccines?
No. Members will have no cost share requirement for COVID-19 vaccines. This includes any vaccines administered over more than one injection.
Will Sutter Health Plus cover COVID-19 vaccines administered by out-of-network or out-of-area providers?
Sutter Health Plus recommends that members contact their PCP before seeking COVID-19 vaccines out-of-network or out-of-area. However, Sutter Health Plus will cover COVID-19 vaccines administered by out-of-network or out-of-area providers in accordance with the requirements established by the CARES Act.
Will Sutter Health Plus inform providers about the no cost share requirement for COVID-19 vaccines?
Yes. Sutter Health Plus will inform Sutter Health and affiliated medical groups of this information by December 31, 2020, via email.
What should members do if a provider charges cost sharing at the time of service or they later receive a bill related to their COVID-19 vaccine?
Members who are charged cost sharing at the time of service or receive bills for COVID-19 related vaccines should contact Sutter Health Plus Member Services for assistance.
Does Sutter Health Plus cover the cost of the COVID-19 vaccine administration and the vaccine itself?
No. Sutter Health Plus covers costs for the COVID-19 vaccine administration. At this time, the federal government covers the cost of the COVID-19 vaccine.
Sutter Health Plus will ensure members do not have cost share for COVID-19 vaccines whether obtained from an in-network or out-of-network provider.
Will members have cost share for office visits or other services received while getting the COVID-19 vaccine?
The COVID-19 vaccine and administration of the vaccine will have no cost share to the member. Depending on the reason for the office visit or other services, they may have cost share applied.
- If the COVID-19 vaccine was administered during a preventive office visit or service, then there will be no cost share applied to these services
- If the COVID-19 vaccine was administered during a non-preventive office visit or service, then the standard cost share will apply to the office visit or other services
While the vaccine is an important step in the fight against COVID-19, we cannot underscore enough the importance of following the Centers for Disease Control and Prevention’s guidelines: Wear a mask, stay at least six feet apart, avoid crowds, and wash your hands often. It’s especially important that all of us follow these precautions during the upcoming holiday season.
Please stay safe and well.