Seasonal Flu Coverage and Benefits

Whether you are covered for the seasonal flu vaccine depends on the type of AmeriHealth New Jersey coverage you have. All fully-insured AHNJ members have the benefit of a flu shot as an in-network preventive service. Refer to the information below to see what your plan covers and find out where you should go to get vaccinated.

Please note: The following list may not be comprehensive. If you do not see your plan here, please call Customer Service at the number on the back of your ID card for coverage information.

AmeriHealth New Jersey HMO, POS, PPO and EPO

Where you can go for a vaccine

  • HMO and EPO: any eligible in-network provider
    PPO and POS: any eligible provider (in- and out-of-network benefits apply)
  • Participating MinuteClinics® at CVS pharmacies, RediClinics® at Rite Aid pharmacies, and Take Care Health Clinics™ at Walgreens® pharmacies in accordance with your standard benefits plan
  • Any participating in-network pharmacy
  • Vaccination clinics (organized by local health departments) and other private settings (e.g., workplace)

Your coverage for the seasonal flu vaccine

  • Coverage for the seasonal flu vaccine depends on whether your plan includes coverage for immunizations.
  • All AHNJ fully-insured plans cover the vaccine so you will not need a referral, precertification, or preapproval to get the seasonal influenza vaccine.

If your plan covers immunizations:

  • You will not need a referral, precertification, or preapproval to get the seasonal influenza vaccine.
  • If you receive the vaccine from an out of network provider, you may have to pay out of pocket and then submit the form below for reimbursement of up to $50.
  • You may pay an applicable co-pay.

If your plan does include coverage for immunizations and you paid for your influenza vaccine, you may submit a Seasonal Influenza Reimbursement Form.

If you do not know whether your plan covers immunizations, call Customer Service at the number on the back of your ID card.

Preventive Services

Please Note: For members who have 100 percent coverage for preventive services in accordance with the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010, no cost-share (i.e., copayments, deductibles, coinsurance) should be applied for the vaccine and administration of the vaccine when it is administered by an in-network provider.

Coverage is subject to the terms and conditions of the applicable benefit plan. Individual benefits must be verified.

Vaccine Reimbursement

You do not need to pay an up-front fee when you get your flu vaccine at a participating location or wellness event such as those offered by employers for their employees when facilitated by Maxim Healthcare Services, CVS, or Rite Aid.

If you get your flu vaccine at a location other than those listed above, you may have to pay an up-front fee. AmeriHealth New Jersey members with HMO, POS, and PPO plans who receive their vaccine at a non-participating provider may file a reimbursement form to receive reimbursement for their out-of-pocket amount of up to $50 per member, per vaccine.

To receive your reimbursement, complete the form below and mail it, along with a copy of your receipt, to:

AmeriHealth New Jersey Processing Center
P.O. Box 211184
Eagan, MN 55121

Seasonal Influenza Reimbursement Form