The FDA has granted Emergency Use Authorization (EUA) to the Pfizer-BioNTech, Moderna, and Johnson & Johnson vaccines against COVID-19 in the United States! As these vaccines roll out to administration sites, you may have questions about your coverage for the vaccine. You will be charged $0 out of pocket for the vaccine at an in-network provider.
HOW EFFECTIVE ARE VACCINES AGAINST COVID-19?
- Among people aged 50 or older, two doses of the mRNA vaccines provide approximately 90% protection against hospitalization with COVID-19, beginning at 14 days from the second dose.
- The mRNA vaccines still have high efficacy in adults aged 85 years or more, with 83% protection against COVID-19 hospitalization.
- The efficacy with one dose of an mRNA vaccine was lower, at 54% against hospitalization with COVID-19 and 68% against emergency room visits.
- The one-dose Johnson and Johnson vaccine is 68% against hospitalization with COVID-19 and 73% against emergency room visits.
- Read more about the effectiveness of the vaccines here.
Where can I get the vaccine?
Certain providers have registered with the Texas state government to distribute the vaccine.
Because of the very cold storage requirements of some of the COVID-19 vaccines, only certain healthcare facilities and pharmacies have the ability to store and give the vaccine.
Find an appointment to get the vaccine in Texas here: https://getthevaccine.dshs.texas.gov/txces/s/?language=en_US
Once you have located the providers in your community, contact them or check their website to find out what you have to do to get on the waiting list, how you can be notified when vaccines become available, and how to make an appointment to get vaccinated.
Is TML Health paying for the vaccine or is it free?
Your healthcare provider, such as a pharmacy, can charge a fee to administer the vaccine, but our Pharmacy Benefit Manager, Navitus, has negotiated a rate it will pay to in-network pharmacies. You will not pay this amount; your pharmacy benefit will pay.
During the public health emergency, coverage for the vaccine will be provided without cost sharing to the member
If vaccine availability is limited, how will I prove my membership in a priority group, like first responders?
The pharmacies themselves, not TML Health or Navitus, will determine who qualifies to get the vaccine because of their membership in a priority group.
Can my employer require me to be vaccinated to return to work?
New guidance from the Equal Employment Opportunity Commission allows employers to require workers to get COVID-19 vaccinations. Currently the COVID-19 vaccines are approved by the FDA under Emergency Use Authorization (EUA), and supply of the vaccine is limited. You can find more information about the Americans with Disabilities Act, Rehabilitation Act, the Pregnancy Discrimination Act, and other legislation as it relates to the vaccine here. https://www.insurancejournal.com/news/national/2020/12/16/594252.htm
Someone I know has no health insurance. Can they get the vaccine for free?
Yes! The healthcare provider who administers the vaccine to an uninsured person should bill the U.S. Health Resources and Services Administration, not the patient.