What should be covered

1
First Things First . . .Strategies for Financing
Immunization Programs

• What should be covered?
• Who should pay?
• How should compliance be measured?
• Create Standards.

2
What Should Be Covered?

• No clear guidelines on which immunizations should
  be covered. This creates inconsistency in
  benefit plans.
• Should we look for the benefit plan to cover only
  immunizations required for school admission?
• Clear guidelines from ACIP or The American
  Academy of Pediatrics would help
• Even less clarity on coverage guidelines for
  adults
• Who should really get a Flu Shot?

3
Who Should Pay for Immunizations?

• Employee
• Health Plans
• Employer
• Typically we expect Preventative
  Health/Immunizations Services to be covered,
  First Dollar at 100 by Health Plans.

4
How Should Compliance be Managed?

• Health Plan
• Individual doctor or PCP
• Patient/Employee
• The health plan has an overall role in ensuring
  that providers have the appropriate direction,
  incentive and resources to encourage and
  facilitate immunization compliance. Employers
  also have a role in ensuring that benefit plans
  are available with little, if any, barrier to
  compliance. For example, first dollar coverage
  and flexibility with time-off practices.