Guidance on Middlebury Health Plan Coverage for Measles Related Blood Test and Vaccinations
On May 21, Karen Miller, Vice President of Human Resources and Chief Risk Officer, informed employees via email that in the event of a Measles outbreak, Middlebury would require employees to provide documentation of evidence of immunity. It was suggested that employees contact their healthcare provider and obtain copies of immunization records, or blood test results proving immunity, in case proof is needed.
The following information is provided as further guidance for employees enrolled in Middlebury’s health plan, outlining what Middlebury’s health plan would cover for employees who may find they need to get a blood test to determine or prove immunity, or for those who need the vaccine. If you are not enrolled in Middlebury’s health plan, please reach out to your own health plan administrator for coverage details.
The Measles vaccine is part of the vaccine program and covered under Middlebury’s plan at 100%, even for adults. Please take note of the steps to follow below:
- If obtaining the vaccine at a pharmacy, locate a pharmacy participating in the Cigna vaccine program (please note that not all pharmacies in the regular Cigna network participate in the vaccine program).
Pharmacies participating it the vaccine program in Middlebury, VT:
- Hannaford Food and Drug
(802) 388-6349 260 Court St Middlebury, VT 05753
- Walgreens, formerly Rite Aid
(802) 388-9573 263 Court St Middlebury, VT 05753
Pharmacies participating it the vaccine program in Monterey, CA:
- Walgreens #7081
(831) 644-9057 416 Alvarado St Monterey, CA 93940
- Rite Aid 06769
(831) 372-8085 499 Alvarado St Monterey, CA 93940
- Rite Aid 05882
(831) 375-8900 1301 Munras Ave Monterey, CA 93940
- CVS Pharmacy #09320
(831) 655-5411 686 Lighthouse Ave Monterey, CA 93940
Participating pharmacies in other locations can be found at this link: CIGNA_Pharmacy_Vaccine_Program_Directory
Call the pharmacy first to see if the vaccine is stocked, and to ask whether a prescription from your provider is required in order to get the vaccine.
- If the vaccine if received during an office visit, the vaccine itself will be covered at 100%, however the office visit charge and coverage will vary depending on the purpose for the visit and how the visit is coded (preventative visit, nurse visit, lab visit, non-preventative visit) by the provider’s billing office.
The Middlebury health plan will cover the blood tests to test for Measles immunity. However, be aware that it may be billed various ways:
- If it is billed with a wellness preventative code, then it is covered at 100% of maximum allowable.
- If it is billed with a diagnosis code other than preventative, then it is covered at 80% of the maximum allowable. However, it may also be subject to the deductible if it is drawn outside of the provider’s office (and not coded as preventative).
- If the provider sends the blood test orders to a lab, then the provider will inform the lab which codes to use. If there is no order from the provider, the lab indicates the codes. To ensure that the lab bills properly, the referring doctor will need to write a script to the lab indicating it’s for preventative purposes.
As previously suggested, please work with your healthcare provider to determine the next steps appropriate for you.