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Prepare your workplace for COVID-19 vaccines

As COVID-19 vaccines continue to be developed and approved, it's important to understand the facts. Learn the latest on Iowa and South Dakota's rollout phases, vaccination costs, vaccine advocacy and preparing to safely return to work.

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62% of the U.S. population say they want to wait, are uncertain or don't plan to get the vaccine at all.

Frequently Asked Questions for Employer Groups

Wellmark is following these recommended guidelines for all of its members:

On March 15, 2021, CMS updated the Medicare payment rates for COVID-19 vaccine administration. Effective for services furnished on or after March 15, 2021, the new Medicare payment rate for administering a COVID-19 vaccine is approximately $40 to administer each dose of a COVID-19 vaccine.

This means that starting on March 15, 2021, for single dose COVID-19 vaccines, Medicare pays approximately $40 for its administration. Starting on March 15, 2021, for COVID-19 vaccines requiring multiple doses, Medicare pays approximately $40 for each dose in the series.

Prior to March 15, Wellmark's payment rates were as follows:

Pfizer 1st dose: 0001A = $17.00
Pfizer 2nd dose: 0011A = $29.00

Moderna 1st dose: 0002A = $17.00
Moderna 2nd dose: 0012A = $29.00

Johnson & Johnson single dose: $29.00

If the vaccine is administered in a physician's office, the cost will fall under medical. If administered in a pharmacy, it will fall under your pharmacy plan.

Each state health department is in charge of its state's vaccine distribution and administration plans. Please contact your state health department or visit their website for more information.

Iowa: idph.iowa.gov External Site

South Dakota: doh.sd.gov External Site

The Advisory Committee on Immunization Practices (ACIP) recommends who should be included in each phase of vaccine distribution. Currently, ACIP has released detailed information regarding Phases 1(a)-1(c). Each state health department is in charge of its state's vaccine distribution and administration plans. Please contact your state health department or visit their website for more information.

Iowa: idph.iowa.gov External Site

South Dakota: doh.sd.gov External Site

It depends who is conducting the onsite vaccination clinics. For example, many nursing homes have contracted with pharmacies in the distribution plan to come onsite and administer the vaccine to residents and employees. We would expect the pharmacy to be submitting the claims for administration to the applicable health plan.

Each state health department is in charge of its state's vaccine distribution and administration plans. Please contact your state health department or visit their website for more information on where and when to get your vaccination.

Iowa: idph.iowa.gov External Site

South Dakota: doh.sd.gov External Site

No. You should not be charged any amount for the COVID-19 vaccine when received from Operation Warp Speed participating providers during the public health emergency.

Yes, the cost share for the vaccine will be waived as required by the CARES Act.

Yes, the cost share for the vaccine will be waived when administered out of network during the public health emergency.

If the vaccine has been approved or authorized by the FDA, it would be covered.

No.

This may be because the second dose was administered outside of the public health emergency period and you have a grandfathered plan. Grandfathered plans were not required to cover the COVID-19 vaccine without cost-share and did so during the public health emergency to assist public health agencies and their vaccination efforts.

Non-grandfathered plans (ACA plans) are required to cover the COVID-19 vaccination at no cost-share regardless of when it is administered.

Please contact your health care provider. They will know the best course of action for you.

You should not be charged any amount for the COVID-19 vaccine when received from Operation Warp Speed participating providers during the public health emergency. Contact your state health department or visit their website to find a participating provider.

Iowa: idph.iowa.gov External Site

South Dakota: doh.sd.gov External Site

NOTE: If a patient receives the vaccine while visiting a provider for services other than the COVID-19 vaccination, the member will be required to pay cost shares (according to their benefits) for those non-related services.

Please contact your health care provider. They will know the best course of action for you.

It depends on which of vaccine you are given. Please contact your health care provider. They will know the best course of action for you.

There are different recommended timeframes for each EAU-approved vaccine:

Pfizer: 2 doses, 21 days apart
Moderna: 2 doses, 28 days apart
Johnson & Johnson: Only 1 dose needed

The single dose vaccine has been approved for emergency use by the FDA and ACIP. It will be covered at no cost-share to members for most plans, just like the 2 dose vaccines.