Standard Covered Immunizations

 

Please review your Summary Plan Description (SPD), or benefit booklet, to find out if it directs you to this web site.

 

Routine/preventive immunizations are generally covered by health plans administered by Blue Cross and Blue Shield of Alabama when provided by a PMD or PPO physician. Routine/preventive refers to immunizations that are performed prior to the onset of signs or symptoms of illness, condition or disease, or services which are not diagnostic. Please note that immunizations which are job-related or due to employment reasons are not covered.

 

Below you will find a listing of eligible immunizations. An effective date may be listed beside some of the immunizations. Coverage for these immunizations is only available after the specified date. Coverage is subject to age and frequency of immunization recommendations issued by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP). Some health plans may not cover any or all of these immunizations, or may provide coverage for additional immunizations. Any variance will be noted in the SPD.

 

Immunization Description Abbreviation Restrictions
Immunization Administration    
Hepatitis A   Effective date of service 03/01/2006
Hepatitis A and B   Effective date of service 03/01/2006
Hemophilus Influenza B Vaccine HIB  
Influenza Virus Vaccine   Effective date of service 12/01/2006 FluMist is included as a covered influenza virus vaccine (Coverage is limited based on the specific FDA labeling)
Pneumococcal Conjugate PCV  
Rotavirus Vaccine    
Diphtheria, Tetanus, Acellular Pertussis DTaP  
Diphtheria, Tetanus DT  
Tetanus Toxoid    
Mumps Virus Vaccine (Live)    
Measles Virus Vaccine (Live)    
Rubella Virus Vaccine    
Measles, Mumps and Rubella Vaccine MMR  
Measles, Mumps, Rubella, and Varicella Vaccine MMRV  
Poliomyelitis Vaccine IPV  
Adult Tetanus and Diphtheria Toxoids (Absorbed) Td  
Tetanus, Diphtheria, Acellular Pertussis Tdap  
Varicella (Chicken Pox) Vaccine    
Diphtheria Toxoid    
Diphtheria, Tetanus, Acellular Pertussis and Hemophilus Influenza B Vaccine DTaP-Hib  
Diphtheria, Tetanus Toxoids, Acellular Pertussis Vaccine, Hepatitis B, and Poliovirus Vaccine, Inactivated DTaP-HepB-IPV  
Diphtheria, Tetanus Toxoids, Acellular Pertussis Vaccine, Hemophilus Influenza Type B, and Poliovirus Vaccine, Inactivated DTaP-Hib-IPV Effective date of service 6/26/2008
Diptheria, Tetanus Toxoids, Acellular Pertussis Vaccine and Poliovirus Vaccine, Inactivated DTaP-IPV Effective date of service 6/26/2008
Meningococcal Polysaccharide Vaccine   Effective date of service 01/01/2005
Meningococcal Conjugate Vaccine   Effective date of service 09/01/2005
Hepatitis B Vaccine (Active Immunizations) HepB  
Hepatitis B and Hemophilus Influenza B Vaccine (Active Immunization) HepB - Hib  
Human Papilloma Virus (types 6, 11, 16 and 18); Gardasil® HPV Effective date of service 09/01/2006. This is covered for females only. Effective date of service 1/08/2011.  This includes males ages 9-21 years
Human Papilloma Virus (types 16 and 18); Cervarix® HPV Effective date of service 12/01/2009, covered for females only, ages 10-26
Zoster (Shingles) Vaccine   Effective date of service 11/01/2006; Please note the age for this vaccine is 60 years of age and older based on the CDC/ACIP