Flu shot coverage by location

Where you can get a flu shot that Priority Health will pay for

If you have vaccine coverage, you can get flu shots at many different locations. See the chart below for detailed information.

Do you need a flu shot?
Check our Staying healthy during flu season page for answers.

Before you get your shot, call the pharmacy or other place offering flu shots to:

• Make sure they are in our network, which means they "contract with Priority Health." For example, if a pharmacy is not in the Priority Health Vaccine Network, out-of-network benefits may apply. You can use the online "Find a Doctor" directory on this website to look up doctors, urgent care centers, health departments and other health care providers to see if they're in our network.
  Go to Find a Doctor now
  View or print the 12-page list of Vaccine Network pharmacies in Michigan (93KB PDF)
• Ask if they have vaccines in stock and will administer them to you. (Some pharmacies only give shots to people in certain age groups.)

Jump down this page to find out how to get reimbursed when you've paid for your own flu shot.

Seasonal Flu and h1n1 Flu vaccine coverage by plan and location
HMO or EPO PLAN	POS PLAN	PPO PLAN	MIChild	Medicaid	Medicare
NOTE: If you are covered by an employer that self-funds your medical plan, they may not cover flu shots.					NOTE: If PriorityMedicare Rx (Part D) is your only plan with us, you don't have vaccine coverage.
Coverage at physician offices
Covered when given at any office, in or out of our network.	Covered when given at any office, in or out of our network: Preferred benefit level when given by in-network providers Alternate benefit level for out-of-network providers	Covered when given at any office, in or out of our network: In-network benefit level when given by in-network providers Out-of-network benefit level for out-of-network providers	Covered when given at any office, in or out of our network.	Covered when given at any office, in or out of our network.	Covered when given at any office, in or out of our network. Through 12/31/2009, the out-of-network deductible and benefit level applies. Beginning 1/1/2010, there will be no difference in benefit level.
Coverage at Community Clinics
HMO or EPO	POS	PPO	MIChild	Medicaid	Medicare
Covered, except for intranasal vaccines If the clinic contracts with Priority Health, it must bill us directly. Member cannot file a claim form. If the clinic does not contract with Priority Health, it can bill us or the member can file a claim form for reimbursement.	Covered, except for intranasal vaccines If the clinic contracts with Priority Health it must bill us directly. Member cannot file a claim form. Preferred benefit level applies. If the clinic does not contract with Priority Health, it can bill us or the member can file a claim form for reimbursement. Alternate benefit level applies.	Covered, except for intranasal vaccines If the clinic contracts with Priority Health it must bill us directly. Member cannot file a claim form. In-network benefit level applies. If the clinic contracts with Priority Health, it can bill us or the member can file a claim form for reimbursement. Out-of-network benefit level applies.	Covered, except for intranasal vaccines If the clinic contracts with Priority Health, it must bill us directly. Member cannot file a claim form. If the clinic does not contract with Priority Health, it can bill us or the member can file a claim form for reimbursement.	Covered for adults only If the clinic contracts with Priority Health, it must bill us directly. Member cannot file a claim form. If the clinic does not contract with Priority Health, it can bill us or the member can file a claim form for reimbursement.	Covered at $0 copay If the clinic contracts with Priority Health, it must bill us directly. Member cannot file a claim form. If the clinic does not contract with Priority Health, it can bill us or the member can file a claim form for reimbursement. Through 12/31/2009, the out-of-network deductible and benefit level applies. Beginning 1/1/2010, there will be no difference in benefit level.
Coverage for home health care services
HMO or EPO	POS	PPO	MIChild	Medicaid	Medicare
Covered (except for intranasal vaccines) by all plans offering flu shot coverage if the home health care service contracts with Priority Health and bills Priority Health directly. The cost for administering the shot is included in the cost of the nursing visit.
Coverage at health departments
HMO or EPO	POS	PPO	MIChild	Medicaid	Medicare
Covered If the department contracts with Priority Health, it must bill us directly. Member cannot file a claim form for reimbursement. If the department does not contract with Priority Health: It must bill us for H1N1 vaccine administration. It may bill Priority Health, or the member can pay and then file a claim form for reimbursement for, a seasonal flu vaccination.	Covered If the department contracts with Priority Health, it must bill us directly. Member cannot file a claim form for reimbursement. If the department does not contract with Priority Health: It must bill us for H1N1 vaccine administration. It may bill Priority Health, or the member can pay and then file a claim form for reimbursement for, a seasonal flu vaccination. Alternate benefit level applies.	Covered If the department contracts with Priority Health, it must bill us directly. Member cannot file a claim form for reimbursement. If the department does not contract with Priority Health: It must bill us for H1N1 vaccine administration. It may bill Priority Health, or the member can pay and then file a claim form for reimbursement for, a seasonal flu vaccination. Out-of-network benefit level applies.	Covered If the department contracts with Priority Health, it must bill us directly. Member cannot file a claim form for reimbursement. If the department does not contract with Priority Health: It must bill us for H1N1 vaccine administration. It may bill Priority Health, or the member can pay and then file a claim form for reimbursement for, a seasonal flu vaccination.	Covered If the department contracts with Priority Health, it must bill us directly. Member cannot file a claim form for reimbursement. If the department does not contract with Priority Health, it must bill us directly.	Covered All health departments are considered out-of-network, so the out-of-network deductible and benefits apply. Member can file a claim form for reimbursement.
Coverage at pharmacies in the Vaccine Network
HMO or EPO	POS	PPO	MIChild	Medicaid	Medicare
Covered if the member has a Priority Health prescription drug plan. Pharmacy will bill Priority Health directly.	Covered if the member has a Priority Health prescription drug plan. Pharmacy will bill Priority Health directly.	Covered if the member has a Priority Health prescription drug plan. Pharmacy will bill Priority Health directly.	Covered for H1N1 flu vaccine only.	Covered for H1N1 flu vaccine only.	Part B benefit covered. Pharmacy will bill Priority Health directly. Not covered for members with Part D (drug coverage) only.
Coverage at pharmacies not in the Vaccine Network
HMO or EPO	POS	PPO	MIChild	Medicaid	Medicare
Covered. Member can pay and then file a claim form to be reimbursed.	Covered. Member can pay and then file a claim form to be reimbursed.	Covered. Member can pay and then file a claim form to be reimbursed.	Covered. Member can pay and then file a claim form to be reimbursed.	Covered for H1N1 flu vaccine only	Out-of-network benefits apply; member can pay and then file a claim form to be reimbursed.
Coverage at urgent care centers
HMO or EPO	POS	PPO	MIChild	Medicaid	Medicare
Covered If the center contracts with Priority Health, it must bill Priority Health directly. Member cannot file a claim form to be reimbursed. If the center does not contract with Priority Health, the member can pay and then file a claim form to be reimbursed. Your urgent care copay will not apply if only service is flu vaccine.	Covered If the center contracts with Priority Health, it must bill Priority Health directly. Member cannot file a claim form to be reimbursed. If the center does not contract with Priority Health, the member can pay and then file a claim form to be reimbursed. Alternate benefit level applies. Your urgent care copay will not apply if only service provided is flu vaccine.	Covered If the center contracts with Priority Health, it must bill Priority Health directly. Member cannot file a claim form to be reimbursed. If the center does not contract with Priority Health, the member can pay and then file a claim form to be reimbursed. Out-of-network benefit level applies. Your urgent care copay will not apply if only service provided is flu vaccine.	Covered If the center contracts with Priority Health, it must bill Priority Health directly. Member cannot file a claim form to be reimbursed. If the center does not contract with Priority Health, the member can pay and then file a claim form to be reimbursed. Your urgent care copay will not apply if only service provided is flu vaccine.	Covered  for adults only. If the center contracts with Priority Health, it must bill Priority Health directly. Member cannot file a claim form to be reimbursed. If the center does not contract with Priority Health, it can bill us or the member can pay and then file a claim form to be reimbursed. Your urgent care copay will not apply if only service provided is flu vaccine.	Covered at $0 copay If the center contracts with Priority Health, it must bill Priority Health directly. Member cannot file a claim form to be reimbursed. If the center does not contract with Priority Health, the member can pay and then file a claim form to be reimbursed.
Coverage at work site flu clinics
HMO or EPO	POS	PPO	MIChild	Medicaid	Medicare
Covered if the health care organization giving the shots contracts with Priority Health and bills Priority Health directly; member cannot file a claim form for reimbursement. Not covered if the member's employer has arranged a discount with the health care organization (even if contracted) and the organization will not bill Priority Health directly; member cannot file a claim form to be reimbursed.	Covered if the health care organization giving the shots contracts with Priority Health and bills Priority Health directly; member cannot file a claim form for reimbursement. Not covered if the member's employer has arranged a discount with the health care organization (even if contracted) and the organization will not bill Priority Health directly; member cannot file a claim form to be reimbursed.	Covered if the health care organization giving the shots contracts with Priority Health and bills Priority Health directly; member cannot file a claim form for reimbursement. Not covered if the member's employer has arranged a discount with the health care organization (even if contracted) and the organization will not bill Priority Health directly; member cannot file a claim form to be reimbursed.	Covered if the health care organization giving the shots contracts with Priority Health and bills Priority Health directly; member cannot file a claim form for reimbursement. Not covered if the member's employer has arranged a discount with the health care organization (even if contracted) and the organization will not bill Priority Health directly; member cannot file a claim form to be reimbursed.	Covered if the health care organization giving the shots contracts with Priority Health and bills Priority Health directly; member cannot file a claim form for reimbursement. Not covered if the member's employer has arranged a discount with the health care organization (even if contracted) and the organization will not bill Priority Health directly; member cannot file a claim form to be reimbursed.	Not applicable

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How to get reimbursed if you paid for your own flu shot

Be sure to check location chart above. You can only file a claim under certain circumstances.

• PriorityHMO^SM, PriorityPOS^SM, and PriorityPPO^SM plan members can print and send us a Member Reimbursement form (62KB PDF)
• PriorityMedicare^SM plan members (except for members who have the PriorityMedicare Rx^SM plan) can print and send us a Medicare Member Reimbursement form (102KB PDF)