Meningitis Vaccine/Empire Plan
|
TO: NYSCOPBA Chief Sector Stewards FROM: Sharon Smith, Health Benefits Specialist DATE: July 18, 2005 RE: Meningitis Vaccine/Empire Plan This memo is a follow-up to mine dated June 3, 2005, regarding the meningitis vaccine becoming a covered benefit under the Empire Plan. In that memo, I informed you that the vaccine would be a covered benefit effective July 1, 2005. Be advised that I just received notification from the Governor's Office of Employee Relations that the New York State Department of Insurance notified Civil Service of the existence of an Insurance Department Circular Letter (No. 34 - 2000) that requires insurers, HMOs, etc., to provide coverage effective on the date of the change. In case of the meningitis vaccine, the date of change is the date the Center of Disease Control and the American Academy of Pediatrics amended their policies to recommend coverage. That date is May 25, 2005. As a result of the above, United HealthCare has been directed to make meningitis vaccine coverage effective May 25th, not July 1st. Because this change is being implemented retroactively, United HealthCare is reviewing claims records and reconsidering any meningitis vaccine claims that fit the criteria and were denied. Members do not need to take any action - reimbursement for the full cost of the service will be sent to them automatically. To recap, those covered are as follows: Dependent children to age 19 and those in the targeted population will be eligible to receive the meningitis vaccine under both the participating provider and basic medical components of the Empire Plan. Full-time dependent students age 19 and over will be eligible for vaccine coverage under the adult immunization benefit which is through a participating provider only. In order for adequate supplies of the vaccine to be maintained, providers are being advised to vaccinate children ages 11, 12 and 17, as well as those college students in the identified risk group. Students in the 13 to 16 age range will receive the vaccine in subsequent years. Vaccination at age 11 can protect children from the disease through college. However, since the vaccine is specific to certain strains of meningitis bacteria, it will not protect people from all meningococcal disease. Members should discuss the appropriateness of the vaccine for their children with their pediatrician. Anything you can do to help get this information to your members will be appreciated. Thank you for your assistance in this regard. Should you have any questions, feel free to contact me.
|
