GTL UNL STHHC Prescription Drug Benefit coverage question

[LostDollar]

Does the Prescription Drug Benefit included with these plans include reimbursement for vaccines?

Does it include reimbursement on Medicare Part B covered vaccines such as Flu or Pneumonia shots given at a pharmacy?

Does it include reimbursement on Medicare Part D covered vaccines such as Tetanus given at a pharmacy?

 

[Northeast Agent]

Huh? Most shots are free under Part B (after you meet the deductible, if applicable).

The shingles shot is a different story, as it falls under Part D.

 

[LostDollar]

the shots Part B covers are very limited.
They are not subject to the deductible.
(see pages 40 and 45 in Medicare and You)

Whether or not Medicare pays for something is not relevant to the insurance coverage I am inquiring about.

I am used to thinking about drugs as tablets or capsules.

It has occurred to me to wonder if vaccines such as Flublok Quad administered at the pharmacy or prescription toothpastes such as Prevident 5000 will count as name brand drugs for the STHHC prescription drug coverage.

I created a separate thread for this because it does not relate to the Kemper Home Health Care plan and because I did not want the question buried in the Kemper thread.

My belief is the answer to my question should be yes, but I don't know for sure and was interested in what others might say.

 

[rousemark]

the shots Part B covers are very limited.
They are not subject to the deductible.
(see pages 40 and 45 in Medicare and You)

Whether or not Medicare pays for something is not relevant to the insurance coverage I am inquiring about.

I am used to thinking about drugs as tablets or capsules.

It has occurred to me to wonder if vaccines such as Flublok Quad administered at the pharmacy or prescription toothpastes such as Prevident 5000 will count as name brand drugs for the STHHC prescription drug coverage.

I created a separate thread for this because it does not relate to the Kemper Home Health Care plan and because I did not want the question buried in the Kemper thread.

My belief is the answer to my question should be yes, but I don't know for sure and was interested in what others might say.

Flu shots, etc. would not be covered as you do not have to have a prescription to get them..

 

[LostDollar]

If prescriptions are the only key here:

The toothpaste is definitely covered. Prevident 5000 is a prescription only flouride toothpaste. It has to be prescribed by a Dr or Dentist.

Flu and Pneumonia may be covered. I can't tell for sure about a prescription requirement for Flublok Quad and Prevnar 13. What I can definitely say is the pharmacy receipt paperwork indicates they were both prescribed under the authority of a local MD with an NPI. Their pharmacy receipt stubs look just like the ones for my monthly meds and the toothpaste.

I am expecting that the pharmacy's receipt stub for a tetanus shot using something like Boostrix or Adacel will come out looking the same, ie a prescription under the same Dr.

I guess I will see what happens.

 

[Yagents]

Can't wait to hear the update

 

[LostDollar]

Drugs@FDA Glossary of Terms

FDA includes biological products in the definition of drugs.

Drug
A drug is defined as:

• A substance recognized by an official pharmacopoeia or formulary.
• A substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease.
• A substance (other than food) intended to affect the structure or any function of the body.
• A substance intended for use as a component of a medicine but not a device or a component, part or accessory of a device.
• Biological products are included within this definition and are generally covered by the same laws and regulations, but differences exist regarding their manufacturing processes (chemical process versus biological process.)

 

[LostDollar]

PRESCRIPTION DRUG CLAIM FILING FORM on your SHORT-TERM HOME HEALTH CARE COVERAGE

• Do ask your pharmacy for a computer summary print out of your RX history when possible

• Do submit proper proof of prescription drugs
which consists of:

• Claimant name on receipt
• Name of the prescribed medication
• Medication RX number (NDC number)
• Pharmacy name
• Date filled by the pharmacy

 

[LostDollar]

POLICY DEFINITIONS

Prescription Drug means a drug which:
(a) requires a Doctor’s prescription in order to obtain it; and
(b) is dispensed by a licensed pharmacist.

Prescription Drug Policy Year Maximum means the maximum benefit amount We will pay for all Your covered Prescription Drugs in a Policy Year. The Prescription Drug Policy Year Maximum is shown on the Benefits Schedule.

Two Kansas pharmacies from which I have receipts appear to be operating under a protocol which requires a physician prescription for a vaccine prior to its administration by a pharmacist.

I am expecting that the year end pharmacy RX history listing will include all prescriptions filled at the pharmacy.

This would mean that the Flu, Pneumonia and Tetanus vaccines meet the requirements for coverage by the policy. How the carrier will process a claim remains to be seen.