Coverage for the Influenza and Pneumococcal Vaccines
Coverage for the Influenza and Pneumococcal Vaccines in the Federal Employee Health Benefit Program
One of the six actions Partnership and its collaborating organizations recommend to strengthen adult immunization is the following:
The Federal Employee Health Benefit Program (FEHBP) should stipulate that participating health insurance plans provide first dollar coverage of influenza and pneumococcal vaccines for adults included in the current recommendations of the Advisory Committee on Immunization Practices.
FEHBP should do this because:
It will protect federal employees from diseases that lead to missed work days, hospitalizations, and in some cases, death.
It will bring FEHBP into alignment with U.S. Public Health Service recommendations.
It will set the right example for private sector employers.
A Partnership for Prevention analysis of coverage for the influenza and pneumococcal vaccines among plans participating in the 2005 FEHBP shows that while coverage is generally very good, it is not complete and there is substantial variation across plans.
Partnership researched the “benefit overview” for adult preventive care regarding influenza vaccine and pneumococcal vaccine of the health insurance plans participating in the 2005 FEHBP. The states with the top ten concentrations of Federal civilian employees were selected to provide a reasonable “snapshot” of the current status. This review included approximately 1.3 of the 2.7 million Federal civilians employed nationwide.
Both influenza and pneumococcal vaccines were “covered benefits” by every insurer in every market reviewed, although coverage was not necessarily “first dollar.” Co-pays and deductibles varied depending upon insurance product and option. Regarding the pneumococcal immunization, all offered the vaccine to their members “age 65 and older,” with the same parameters for co-pays and deductibles, but few plans include coverage for high-risk individuals under the age of 65.
Our state-specific tables on FEHBP coverage are only available from this webpage.