Effective date of service 12/01/2006 FluMist is included as a covered influenza virus vaccine (Coverage is limited based on the specific FDA labeling), Measles, Mumps, Rubella, and Varicella Vaccine, Adult Tetanus and Diphtheria Toxoids (Absorbed), Diphtheria, Tetanus, Acellular Pertussis and Hemophilus Influenza B Vaccine, Diphtheria, Tetanus Toxoids, Acellular Pertussis Vaccine, Hepatitis B, and Poliovirus Vaccine, Inactivated, Diphtheria, Tetanus Toxoids, Acellular Pertussis Vaccine, Hemophilus Influenza Type B, and Poliovirus Vaccine, Inactivated, Diptheria, Tetanus Toxoids, Acellular Pertussis Vaccine and Poliovirus Vaccine, Inactivated, Hepatitis B Vaccine (Active Immunizations), Hepatitis B and Hemophilus Influenza B Vaccine (Active Immunization), Human Papilloma Virus (types 6, 11, 16 and 18); Gardasil, Effective date of service 09/01/2006. Members Can Get Vaccines at Pharmacies Effective immediately, members 18 years of age and older with pharmacy benefits can now go to a participating Express Scripts retail pharmacy to receive 11 different immunizations. Peak months for the flu season in Michigan . If you aren't clear about any of the underlined terms used in this form, see the Glossary. with Dental Blue Pediatric Essential Benefits, HMO Blue New England $1500 Deductible with HCCS Medicare prescription drug plans (Part D) usually cover all commercially available vaccines needed to prevent illness, like the shingles shot. We do not claim responsibility for its accuracy. For those who still get shingles after being immunized, the vaccine can reduce pain, including the type of pain that lasts after shingles. with Dental Blue Pediatric Essential Benefits, HMO Blue New England Basic Coinsurance Please review your Benefit Booklet, to find out if it directs you to this web site. 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. Any variance will be noted in the Benefit Booklet. with Dental Blue Pediatric Essential Benefits, You can also login to MyBlue to download documents related to your plan and to review your benefits and coverage. This new site may be offered by a vendor or an independent third party. Medicare Part B (Medical Insurance) cover the shingles shot. You typically must work directly with the government to qualify for your program or benefits. Important Information About Medicare Plans. This vaccine is not used to treat shingles or nerve pain from shingles. For example, in the U.S., only about 50 tetanus cases are reported every year thanks to vaccinations. Watch this video to take a closer look at your preventive care benefits and see how they can help you stay on top of your health. Blue Cross Blue Shield of Massachusetts (bluecrossma.org) is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. Licensed Insurance Agent and Medicare Expert Writer. How much you pay will vary based on the plan you choose. ACIP recommends Shingrix for people age 50 years or older. These can help you and your doctor identify lifestyle changes you can make to avoid certain health conditions. with Dental Blue Pediatric Essential Benefits, Access Blue New England Saver $2000 Get access to your member portal. Blue Cross Blue Shield of Massachusetts Covers COVID-19 Vaccines at No Cost to Members Coverage includes Pfizer/BioNTech vaccine and any other COVID-19 vaccines that receive emergency use authorization from the FDA (including Moderna's mRNA-1273) Flu Shot Finder Infographic February 25, 2021 For a list of HRSA-supported Womens Preventive Services Guidelines, click here. How do I know what I'm covered for? Learn more here. For some, long-term pain continues even after the rash is gone, a condition known as postherpetic neuralgia. To learn more, visit AHealthyMe.com. What's the difference between HMO and PPO plans? 3 of 11 Highmark Blue Cross Blue Shield: Community Blue PPO Coverage Period: 01/01/2016 - 12/31/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family | Plan Type: PPO Questions: Call 1-866-594-1729 or visit us at www.highmarkbcbs.com. Stanford Health Care and its physicians are in-network with out of state Blue Cross/Blue Shield plans, as long as the plan uses the nationwide network of providers. 4 Tier Drug List. Coverage for these immunizations is only available after the specified date. Most PDF readers are a free download. You can also find information in the benefits booklet you received separately. To find a vaccine pharmacy, visit bcbsil.com. Most PDF readers are a free download. Since vaccines are preventive care, they come at no cost to you when visiting providers in FEP's vaccine network. We are a private company. By continuing to use this website, you consent to these cookies. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield Companies. Whether in or outside of our service area, members should be able to receive a flu shot from in-network . BOSTON August 19, 2021 Blue Cross Blue Shield of Massachusetts ("Blue Cross") today confirmed it will cover, with no cost share to members, the administration of a third booster dose of COVID-19 mRNA vaccines, pending authorization from the U.S. Food and Drug Administration (FDA) for the general population and in accordance with all federal Syphilis. Protect Your Health with Vaccinations - Blue Cross and Blue Shield's Federal Employee Program Back to BlueNews Protect Your Health with Vaccinations Vaccines can prevent or reduce your risk of developing deadly diseases. CDC.gov, Shingles Vaccine. with Dental Blue Pediatric Essential Benefits, HMO Blue Select Saver $2000 This is known as the Blue Card network. with Dental Blue Pediatric Essential Benefits, Preferred Blue PPO $2000 Deductible with Dental Blue Pediatric Essential Benefits, Preferred Blue PPO Options Immunizations are important for all ages. , , TM, SM Registered, Service, and Trade Marks are the property of their respective owners. We use cookies on this website to give you the best experience and measure website usage. Any questions regarding those organizations should be addressed to them directly. Individuals attempting unauthorized access will be prosecuted. The best reason to get yourself vaccinated is to protect yourself and the people around you. Vaccines are remarkably effective, inexpensive and easy to get. Check with your plan to be sure it covers Shingrix. First 12 weeks. This is a 4.5-star Medicare Advantage plan with Part D (prescription drug . The CDC recommends adults 50 years and older get two doses of the shingles vaccine called Shingrix to prevent complications from the disease. Insulin users will pay no more than $35 for a month's supply and will not be subject to the deductible. with Dental Blue Pediatric Essential Benefits, HMO Blue New England Premier Value with HCCS ACIP also recommended vaccinating adults older than 26 years old. The flu Unlike other vaccines, it can only be covered by Medicare prescription drug plans (Part D). ACIPs recommendations include immunization schedules for children and adolescents as well as adults, which can be found on the CDC website. There are two ways to add Part D prescription drug coverage to your Medicare health insurance: Sources: 1. Note: This is not a comprehensive list of vaccines covered by Blue Shield . Hematocrit/hemoglobin (Blood count) HIV. Routine Annual Physical Incentive Program, Advisory Committee on Immunization Practices, U.S. Health Resources and Services Administration, American Academy of Pediatrics: Bright Futures, Tubal ligation or tubal occlusion/tubal blocking procedures only. Please contact the pharmacy to make sure these services are available or if you have questions. Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency (collectively "Medicare System Providers"). Medicare Part D plans cover this vaccine. Part D covers a lot more than the shingles vaccine, providing coverage for prescription medications. Yes, the two-dose Shingrix regimen is recommended by the Centers for Disease Control and Prevention (CDC) if you've had shingles or you received the Zostavax vaccine. with Dental Blue Pediatric Essential Benefits, HMO Blue Select $2000 Deductible with Copayment State and Federal Privacy laws prohibit unauthorized access to Member's private information. This material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Members with questions can call the Blue Cross COVID-19 helpline at 1-888-372-1970. Read our guidelines to help avoid common illnesses & diseases year round. We use cookies on this website to give you the best experience and measure website usage. The second dose should be two to six months after the first. Data-driven insights to improve the health of all Americans. Registered Marks of the Blue Cross and Blue Shield Association. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : shingles. Medicare Part B does cover preventive vaccinations that include getting flu shots, pneumonia shots, COVID-19 vaccinations and Hepatitis B shots. 2023 Blue Cross and Blue Shield of Massachusetts, Inc.., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Blue Cross Blue Shield of Massachusetts Covers COVID-19 Vaccines at No Cost to Members, Coverage includes Pfizer/BioNTech vaccine and any other COVID-19 vaccines that receive emergency use authorization from the FDA (including Moderna's mRNA-1273), For further information: Amy McHugh, amy.mchugh@bcbsma.com, 617-246-2311, Nondiscrimination & Translations Resources. Premera Blue Cross Medicare Advantage members generally pay less for Part D vaccines when they are administered at an in-network preferred pharmacy. However, the amount you need to pay usually depends on your insurance. At Blue Cross Blue Shield of Massachusetts we offer you Healthy Blue, a group of programs, discounts and savings, resources, and tools to help you get the most you can from your health care plan. Heres everything you need to know about it. "Since the COVID-19 vaccines first became available, weve been committed to supporting widespread vaccination in our communities," saidDr. Sandhya Rao, chief medical officer at Blue Cross. 1-800-262-BLUE (2583). Thousands of Americans die every year from the flu and flu-related illnesses. If you haven't met your deductible, you will be responsible for the full cost of your vaccine. Many travel vaccines are not covered including: Typhoid; Malaria; Rabies; Breast cancer mammography screenings for . "The surges are worrisome, but we are better off today than when the COVID-19 pandemic started," Yeats said. Preventive Care - Blue Cross and Blue Shield's Federal Employee Program Preventive Care Annual physical exams and other preventive services are free when you use a Preferred provider. Most adults age 50 and older should get vaccinated. Routine/preventive immunizations are generally covered by health plans administered by your plan when provided by a PMD or PPO physician. How long does the shingles vaccine last? The second dose should be two to six months after the first. Medicare Part D is a great way to get coverage, not only for the shingles vaccine but for prescription drugs as well. "We made the commitment at the start of the pandemic in March to cover the cost of a COVID-19 vaccine once it became available," said Katherine Dallow, MD, MPH, vice president of clinical programs and strategy at Blue Cross. Expand All Pharmacy benefits for adult immunizations Medicare Part D coverage Some health plans may not cover any or all of these immunizations, or may provide coverage for additional immunizations. Blue Cross Blue Shield of Massachusetts provides a Summary of Benefits and Coverage (SBC) with online access to the corresponding coverage policy to all of our fully insured members and accounts. The shingles vaccination is covered. They will ask that your provider send them information as to why one of the services above cannot be rendered. with Dental Blue Pediatric Essential Benefits, HMO Blue New England Saver $2000 with Dental Blue Pediatric Essential Benefits, Access Blue Basic with Dental Blue Pediatric Essential Benefits, HMO Blue Basic Deductible with Dental Blue Pediatric Essential Benefits, Access Blue New England Basic $2000 with Dental Blue Pediatric Essential Benefits, Access Blue New England Basic $2000 with HCCS with Dental Blue Pediatric Essential Benefits, Access Blue New England Basic Saver with Dental Blue Pediatric Essential Benefits, Access Blue New England Basic Saver II Blue Cross and Blue Shield of Illinois (BCBSIL) reviews claims to ensure applicable guidelines are met. During your visit, your doctor will determine what tests or health screenings are right for you based on factors such as your age, gender, health status, and health and family history. If you're looking for details about your benefitslike eligibility or annual maximumsthe easiest way is to check things out online or using our app. Log In to the Shopping Cart, Need to Make a Payment? "Blue Cross Blue Shield pays your doctor a . with Dental Blue Pediatric Essential Benefits, Preferred Blue PPO Saver $1500 Medicare Part B vaccines (flu and pneumonia) were previously available with no copay. Medicare covers the shingles vaccine if you have Part D prescription drug coverage as part of your original Medicare or Medicare Advantage plan. They will then make a coverage determination within 24 hours of receipt of sufficient medical records. Zostavax is no longer available in the U.S. The vaccines are free, safe and effective and widely available for anyone age 5 and up. If you need the shingles vaccine and prescription drug coverage, see our guide on how to find the best Part D plan for you, or learn more about Part D first. Adults should make sure theyre up to date on all their vaccinations. Adult vaccines recommended by the Advisory Committee on Immunization Practices, including the shingles vaccine, will be covered with $0 cost-sharing. Shingles is caused by a once dormant chickenpox virus rearing its ugly head to give you a painful rash that can last for up to four weeks. Coverage is subject to age and frequency of immunization recommendations issued by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP). Note: Zostavax will be considered as medically necessity when rendered prior to the discontinuation of the drug. Medicare covers vaccine administration for Medicare Advantage and Medex members when administered by any clinician who accepts Medicare. with Dental Blue Pediatric Essential Benefits, HMO Blue Basic with Dental Blue Pediatric Essential Benefits, HMO Blue Select $1000 Deductible with Dental Blue Pediatric Essential Benefits, HMO Blue Select $1000 Deductible with Copayment Check out the changes and updates to our plan in 2023. with Dental Blue Pediatric Essential Benefits, HMO Blue New England Premier Value with Coinsurance For patients between 15 and 45 years old, ACIP recommends three doses. In addition, some sites may require you to agree to their terms of use and privacy policy. with Dental Blue Pediatric Essential Benefits, HMO Blue New England Basic Copayment We are committed to the relentless pursuit of quality, affordable and equitable health care with an unparalleled consumer experience. Getting the shot before the flu season is in full force gives the body a chance to protect itself. For patient safety, its important that you follow the U.S. Food and Drug Administration (FDA) guidelines and the Advisory Committee on Immunization Practices (ACIP) recommendations and child and adult immunization schedules. with Dental Blue Pediatric Essential Benefits, Preferred Blue PPO Basic Saver The full price for two doses of the shingles vaccine is around $324. Most employer sponsored group plans will include this network, especially if they have employees located in multiple states. Recover reimbursements as per the claim payment recovery process outlined in our participating provider contracts. Learn about the recommended immunizations for children, adolesnce and adults child . Connect with us onFacebook,Twitter,YouTube, LinkedIn, and Coverage, our health news service. The member then submits the prescription drug claim form to their Medicare Part D plan for reimbursement. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Most Medicare drug plans cover at least 50 percent of a drug's retail price. with Dental Blue Pediatric Essential Benefits, HMO Blue New England Saver $3000 Shingrix is an effective vaccine that can protect you against shingles outbreaks and complications like post-herpetic neuralgia. . with Dental Blue Pediatric Essential Benefits, HMO Blue Select $1000 Deductible Also refer to BCBSILs Clinical Payment and Coding Policies (CPCPs) for our Preventive Services Policy (CPCP006).**. Shingles vaccine will apply. Getting vaccinated early is important, because the flu is highly contagious and spreads rapidly. On the other hand, Medicare Part Dor a Medicare Advantage plan that includes Part D coveragetypically does cover the vaccine. So do Medicare Advantage plans that include a prescription drug benefit. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Does Medicare Cover Cover Vision, Cataract Surgery or Glasses? Diabetes. Early fall is the best time to get your flu shot. Weve found that two categories of vaccines are often administered outside FDA and ACIP recommendations: those to prevent HPV and those to prevent shingles caused by the herpes zoster virus. If you are not a member yet, call with Dental Blue Pediatric Essential Benefits, Preferred Blue PPO $2000 Deductible Some health plans may not cover any or all of these immunizations, or may provide coverage for additional immunizations. To make sure you're covered: Once you know whether you're covered, you can get vaccinated by: If you don't have prescription coverage through us, your vaccine may still be covered. Without insurance, you may pay $155 or more per . CDC recommends that adults 50 years and older get two doses of the shingles vaccine called Shingrix (recombinant zoster vaccine) to prevent shingles and the complications from the disease. Below you will find a listing of eligible immunizations. For more information on how Blue Cross is supporting members during the COVID-19 emergency, visit its Coronavirus Resource Center. Zostavax is no longer available in the U.S. ", HMO Blue $1000 Deductible There are also additional guidelines if you're pregnant. So far, a vaccine developed by Pfizer/BioNTech has been authorized for distribution through the FDA's Emergency Use Authorization process. To view this file, you may need to install a PDF reader program. Thus, you have to enroll in a Medicare Advantage plan or a stand-alone Part D drug plan to cover the costs. "We have tests, treatments, and vaccines that can . with Dental Blue Pediatric Essential Benefits, Preferred Blue PPO $3000 Deductible with HCCS Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Registered Marks of the Blue Cross and Blue Shield Association. with Dental Blue Pediatric Essential Benefits, Preferred Blue PPO $500 Deductible with HCCS Consistent with our promise to always put our members first, we are rated among the nations best health plans for member satisfaction and quality. Learn More BCBSRI follows the DOH guidelines when determining which vaccines are . The protection of your privacy will be governed by the privacy policy of that site. Depression. ZOSTER VACCINE is a vaccine used to reduce the risk of getting shingles. Important Legal and Privacy Information|Important Information About Medicare Plans|Privacy Practices For patients between 9 and 14 years old, ACIP recommends two or three doses. Get prepared, says Blue KC medical director. About Blue Cross Blue Shield of Massachusetts Blue Cross has already implemented billing codes for both vaccines. Surprisingly, Original Medicare (Parts A and B) doesnt cover the shingles vaccine, even though it covers other vaccines like the flu vaccine and pneumonia shot. Here's your 2023 drug list (for coverage that renews or starts on or after January 1, 2022): 6 Tier Drug List. At a designated retail pharmacy Medicare does not provide coverage After a $35 calendar-quarter deductible: . Zostavax may also be covered by Medicare prescription drug insurance (Part D), but again, you should check to be sure. Returning Shopper? with Dental Blue Pediatric Essential Benefits, Preferred Blue PPO Saver $3000 Click here to see the full list of recommended immunization for adults. FEP will waive copays for all telehealth services provided by Teladoc during this time for all members. Vaccinations Working to close immunization gaps across all age groups in the U.S. Reports Stories Resources The Centers for Disease Control and Prevention recommends an annual influenza vaccination for everyone 6 months and older. Blue Cross Blue Shield Medicare Advantage Review. Medicare and geriatric care expert, Alex has one motivation behind every word he writes, and thats finding you the best medical coverage for your situation. with Dental Blue Pediatric Essential Benefits, Preferred Blue PPO $3000 Deductible The focus right now should be solely on a widespread public health vaccination campaign so we can rein in this global pandemic.". Visit Anthem.com. with Dental Blue Pediatric Essential Benefits, HMO Blue New England $3000 Deductible with HCCS Blue Cross Blue Shield of Massachusetts -- covers shingles vaccine for patients 50 and over, or adults 18 and older who at increased risk due to immunodeficiency, or immunosuppression caused by . Adult vaccines recommended by the Advisory Committee on Immunization Practices, including the shingles vaccine, will be covered with $0 cost-sharing. Most individuals with private insurance pay little to nothing for both doses of shingles vaccines, whereas those covered by other types of insurance may need to copay some amount. Eligibility.com is not a government website or a government agency. with Dental Blue Pediatric Essential Benefits, HMO Blue Basic Copayment Summary. HPV vaccination rates low despite risks of related cancers, Missing vaccinations during COVID-19 puts our children & communities at risk, Early childhood vaccination trends in America, Improving childhood vaccination and flu shot rates during COVID-19, Turnkey prevention toolkit helps employers promote flu vaccine, Q&A: How insurers can help close the gap in HPV vaccination rates, Why Rhode Island leads on adolescent vaccination rates, Care Vans deliver vaccines to kids in need, Flu season plus pandemic? with Dental Blue Pediatric Essential Benefits, HMO Blue New England $2000 Deductible These visits are a great way to check in with your health. Insulin users will pay no more than $35 for a months supply and will not be subject to the deductible. 2023 Blue Cross and Blue Shield of Massachusetts, Inc.., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Blue Cross Blue Shield of Massachusetts Will Cover COVID-19 Vaccine Boosters at No Cost to Members, Company also announces vaccine requirement for entering office buildings, starting in October, For further information: Amy McHugh, amy.mchugh@bcbsma.com, Nondiscrimination & Translations Resources. ACIP recommends Shingrix for people age 50 years or older. It's recommended that everyone receive routine vaccinations depending on age and medical history. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. with Dental Blue Pediatric Essential Benefits, HMO Blue Select $2000 Deductible an Independent Licensee of the Blue Cross and Blue Shield Association No-Cost Preventive Drug List Medication Covered at $0 Cost to You Effective July 1, 2021 . It was removed from the 2021 ACIP adult immunization schedule. Here's what everyone should know about shingles vaccines. . People who suspect symptoms of shingles should call their doctor or health care provider right away. Registered Marks of the Blue Cross and Blue Shield Association. The shingles vaccination is a Medicare Part D pharmacy benefit, which requires the member to pay in advance of reimbursement. Blue Cross & Blue Shield of Rhode Island (BCBSRI) does not provide reimbursement to the provider for biologicals for immunizations that are supplied by the DOH or any other state or federal agency. PRice ranges for the shingles vaccine Shingrix (given as two shots): Deductible copay: free to $164 for each shot. This is covered for females only. Three out of four Americans eligible for the shingles vaccination still haven't gotten it, according to the CDC. Free. FDA approved in 2017, Shingrix is the leading preventive tool against shingles (herpes zoster virus). Involve your patients in the decision to vaccinate. As a preventitive measure, Blue Cross Blue Shield of Massachusetts members with our pharmacy coverage who are aged 60 and older can now go to a participating retail pharmacy to get a shingles vaccine at no cost. Pediatrix (a combination of DTaP, IPV, and HepB) Diphtheria, Tetanus, Pertussis (DTaP) vaccination . with Dental Blue Pediatric Essential Benefits, Preferred Blue PPO Basic Copayment Members must refer to their Evidence of Coverage or Certificate of Insurance or Policy for plan/policy coverage of preventive health benefits. Visiting a pharmacy that accepts your plan if you have prescription coverage through us. Medicare ensures at-risk people can receive vaccinations at a minimal cost. It's also one of the easiest ways you can stay healthy. Make sure to get all the screenings and vaccines recommended for your age and gender. with Dental Blue Pediatric Essential Benefits, HMO Blue Essential The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. BlueShield offers a full range of insured, self-insured, and government programs and services covering businesses, families, and individuals, as well as life and disability coverage, dental and vision plans and stop-loss coverage. 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 5 (401) 274-4848 WWW.BCBSRI.COM 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use Both vaccines require two separate doses that are given three to four weeks apart, and both doses are required for the vaccine to be fully effective. Learn about preventive health care services covered at Anthem. Compare vaccinations. with Dental Blue Pediatric Essential Benefits, HMO Blue New England Basic Saver Please note that immunizations which are job-related or due to employment reasons are not covered. External link You are leaving this website/app (site). (U.S. National Institute of Allergy and Infectious Diseases) Shingles is a debilitating condition that affects mostly older Canadians. Select Your Gender. with Dental Blue Pediatric Essential Benefits, HMO Blue Premium with Dental Blue Pediatric Essential Benefits, HMO Blue New England Premier Value Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Blue Care Network HMO members can get free vaccinations two ways: 1996-document.write(new Date().getFullYear()); Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. For this reason, its always good to check your plans formulary (or call your insurance company directly) to see which vaccines they cover and which tier those medications fall under. There are more than a dozen vaccines available to you, depending on your situation. Shingles vaccine. with Dental Blue Pediatric Essential Benefits, HMO Blue New England Options Deductible III Annual physical exams and other preventive services are free when you use a Preferred . Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, BCBSILs Clinical Payment and Coding Policies, Consider the services to be experimental, investigational or unproven (EIU), which are not a covered benefit for BCBSIL members; and.