For the time being, the federal government is picking up the cost of the vaccine, with providers being able to charge an administration fee for actually giving the shot. Regulations require that insured and self-funded group health plans must cover the cost of the office visit associated with the vaccine as long as the primary purpose of the visit is to receive the vaccine. And regardless of whether the vaccine is provided in-network or out-of-network, there must be no cost sharing involved.
Plan documents must be modified to reflect the availability of COVID-19 vaccinations and the change must be communicated to plan participants. In the case of self-funded plans, ERISA disclosure rules allow 210 days following the end of the previous plan year for the plan sponsor to issue this notification. With all the questions surrounding COVID-19 vaccines, it is recommended that employers be proactive in letting participants know that vaccinations will be covered.