How COVID-19 Vaccines Impact Self-Funded Plans

How COVID-19 Vaccines Impact Self-Funded Plans

On December 12, 2020, the Center for Disease Control (CDC) Advisory Committee on Immunization Practices issued an interim recommendation for the Pfizer and BioNTech COVID-19 vaccines. The Moderna vaccine was added to the interim recommendation on December 22, 2020.  As of now, vaccine candidates manufactured by AstraZeneca, Janssen, and Novavax are in Phase 3 clinical trials. This signified the beginning of a much anticipated push to distribute and circulate the vaccines. Now that this process has begun, many have questions about the impact these vaccines will have when it comes to healthcare.

What do these COVID-19 vaccines mean for Plan Sponsors of Self-Funded plans?

The CARES Act requires group health plans subject to the Affordable Care Act’s (ACA) preventive care requirements to cover, within 15 days of federal approval, coronavirus vaccines without cost sharing, even for vaccines administered by out-of-network providers. Therefore, as of January 6, 2021, a participant’s receipt of these two approved COVID vaccines, as well as the administrative costs related to the vaccine delivery and distribution, must be covered with $0 participant cost share.

Now, the federal government has absorbed the cost of the several hundred million vaccine doses it purchased as part of Operation Warp Speed, but group health plans remain responsible for covering the full cost of vaccine administration. Boon estimates the average cost to administer the vaccine to be around $25 per injection, $50 for two injections if that is what your vaccine requires.

You may find more information on the COVID-19 vaccines below:

ACIP’s recommendation of the vaccine:

See the CDC’s FAQs for COVID-19 Vaccination:

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