What you need to know about coverage for vaccines and immunizations
Washington state passed HB 2242, which requires health insurers to cover all vaccines and immunizations that are recommended by the Washington State Department of Health (DOH). Self-insured health plans have to cover the vaccines and immunizations that are required by the Affordable Care Act (ACA).
HB 2242 ensures that preventive services, including vaccines, are covered for people who choose to use them. It does not require anyone to use them. It also ensures that these services continue to be covered at no cost to you, meaning no copays, coinsurance, or deductibles if you get the services from a pharmacy or doctor in your health plan’s provider network.
Learn more about DOH’s recommendations for vaccines and immunizations. There are different recommendations for children (0-18 years) and adults.
What you need to know about accessing vaccines and immunizations
They must be administered at an in-network clinic or pharmacy to be covered by your health plan
If you have a health savings account (HSA) plan, you may need to pay a deductible to get preventive supplies or services that are specific to Washington state. However, this can't be more than the minimum deductible for HSA plans.
If you have questions about what your health plan covers, call your health insurer and ask a customer service representative
What you need to know about fully insured and self-funded health insurance plans
HB 2242 applies to fully insured health insurance plans, not self-funded plans. In a self-funded plan, the employer pays the medical bills and hires another company to help run the plan. In a fully insured plan, a health insurance company runs the plan and pays the medical bills for employees.
Self-funded health plans are regulated by the federal government. Fully insured health plans are regulated by OIC. This means fully insured health plans must follow Washington state laws. If you have a problem with your health plan, you can report it directly to our office.
Ask your employer if you have questions about whether your health plan is fully-insured or self-funded. Usually, your human resources department or your benefits coordinator will have that information.