OGB’s PPO health plan covers influenza vaccinations whether the shot is administered at a doctor’s office, health fair, hospital, medical clinic or pharmacy. The charge is paid at 90 percent and is also subject to a deductible of $300 for retirees and $500 for active employees.
If you receive your flu shot from a doctor’s office or medical clinic that is a participant in your health plan’s network, the medical facility will file a claim for you.
If you receive your flu shot at a pharmacy and your pharmacy agrees to file a claim directly with your health plan provider, no action is needed on your part.
However, if the doctor or pharmacy does not file a claim for you, you must file a claim to receive benefits. Here are the steps you need to take...
Get your flu shot and pay for it.
If you have an OGB general-purpose flexible spending arrangement (GPFSA) card, do not use it to pay for the vaccine.
Be sure the receipt includes the date administered, the cost, the vaccine name, the name of the person who received the shot and the medical provider or pharmacist who administered it.
Submit the original receipt (not a cash register receipt or a copy) with the claim form.
Sign and date the form. Mail the form and the original receipt to the address listed on the form.
If you have a general-purpose flexible benefits arrangement (GPFSA), you can file for reimbursement from DataPath Administrative Services (the GPFSA administrator) for any remaining out-of-pocket costs after your claim has been processed and you have received a check and an explanation of benefits (EOB) from OGB. Here’s what to do...