Thursday, October 18, 2012

Immunization Coverage Clarified With New PPACA Guidelines

By Tonya Williams
Employee Relations Specialist

Staff members who carry our health insurance call frequently to inquire if certain immunizations are covered under our plan.  The District’s health insurance plan does not cover any immunizations for any insured members over the age of six.

The Patient Protection and Affordable Care Act (PPACA) brought many changes to employer-sponsored health plans.  Effective October 1, 2012, PPACA set new guidelines that all non-grandfathered health insurance plans must cover all immunizations for members on a plan.  This has caused some confusion for employees on the School District of Janesville’s health insurance plan.  However, the health insurance plan for the employees of the District is grandfathered in.  Because our plan is grandfathered in, our plan will continue to only offer immunizations to dependents under the age of six.

For those members on our health plan over the age of six seeking immunizations, you may continue to receive those at the Rock County Health Department (RCHD).  I have shared this information with Janet Zoellner, Public Health Nursing Director, and she is aware of the District’s immunization coverage. In order to continue receiving immunizations at RCHD, you will have to complete a form confirming that you have insurance, but it does not cover immunizations.  To see a schedule of RCHD’s immunization clinics scheduled throughout the year visit their website at 

Immunizations are the best way to prevent disease; therefore, understanding your coverage will help you determine the best way to vaccinate you and your family.  If you have any questions regarding the District’s coverage on immunizations, please contact Coordinated Health Care at 877-550-3455.

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