Where to get a flu shot 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.
Before you get your shot
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Find out if you need one. Check Who needs a flu shot?
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If your employer self-funds your plan, ask if your plan covers vaccinations. (To find out if your plan is self-funded, look for the SF on your ID card.)
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Make sure the pharmacy or other place offering flu shots is in your plan's network.
Go to Find a Doctor now to look up doctors and pharmacies in your plan's network
View or print the 12-page list of Vaccine Network pharmacies in Michigan (93KB PDF)
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Ask if they have vaccines in stock and will administer them to you. (Some pharmacies only give shots to people in certain age groups.)
After you get your shot
Jump down this page to find out how to get reimbursed when you've paid for your own flu shot.
| Flu shot coverage by plan and location |
|---|
| PriorityEPO and self-funded PriorityPPO plans |
HMO, POS and PPO employer group plans, MyPriority individual plans, Medicaid & MIChild |
Priority Health Medicare |
| If your ID card shows an "SF" after your plan name or you have PriorityEPO, you are covered by an employer that self-funds your medical plan, they may not cover flu shots. |
Covered |
Covered for members of Priority Medicare Advantage plans, which include Medicare Parts A, B, and D. See locations listed below.
Not covered for members of PriorityMedicare RxSM (Part D only), regardless of location.
Learn more about Medicare Parts A, B and D.
|
| Physician offices |
|---|
| Covered |
| Community clinics |
|---|
Covered - Priority Medicare Advantage plan members are covered at $0 copay.
- If the group giving the shots is in your Priority Health plan network, they must bill Priority Health directly. You cannot pay and then file claim forms to be reimbursed.
- If the group giving the shots does not contract with your Priority Health plan network, you can pay and then file a Member Reimbursement form (see below) to be reimbursed by your Priority Health plan.
- Go to Find a Doctor now to look up doctors and pharmacies in your plan's network.
|
Home health care services
|
|---|
Covered - The home health care service must contract with Priority Health and bill Priority Health directly.
- The cost for administering the shot is included in the cost of the nursing visit.
- Intranasal vaccines are not covered.
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| Health departments |
|---|
Covered - Priority Health Medicare Advantage plan members are covered at $0 copay.
- If the health department is in your Priority Health plan network, it must bill Priority Health directly. You cannot pay and then file a claim form to be reimbursed.
- If the health department does not contract with your Priority Health plan network AND you are not a member of a Medicaid plan, you can pay and then file a Member Reimbursement form (see below) to be reimbursed by your Priority Health plan.
- Go to Find a Doctor now to look up health departments in your plan's network.
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| Pharmacies in the Vaccine Network |
|---|
| Covered |
| Pharmacies not in the Vaccine Network |
|---|
Covered - You can pay for your flu shot and file a Member Reimbursement form (see below) to be reimbursed by your Priority Health plan.
|
| Urgent care centers |
|---|
Covered - Priority Medicare Advantage plan members covered at $0 copay.
- If the urgent care center is in your Priority Health plan network, the center must bill Priority Health directly. You cannot pay and then file a claim form to be reimbursed.
- If the urgent care center does not contract with your Priority Health plan network, you can pay and then file a Member Reimbursement form (see below) to be reimbursed by your Priority Health plan.
- Your urgent care copay will not apply if the only service you get is a flu vaccination.
- Go to Find a Doctor now to look up urgent care centers in your plan's network.
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| Work site flu clinics |
|---|
Not applicable for Medicaid
Covered if the health care organization giving the shots is in your Priority Health plan network and bills Priority Health directly; you cannot file a claim form for reimbursement.
Not covered if the member's employer has a discount arrangement with the vaccination provider and the provider is paid directly by the employer. Even if the vaccination provider is in your Priority Health plan network, if you pay a fee, then you cannot file a claim form to be reimbursed.
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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.
