Web Content Display (Global)
Standard Covered Immunizations
Please review your Benefit Booklet, to find out if it directs you to this web site.
Routine/preventive immunizations are generally covered by health plans administered by your plan when provided by a PMD or PPO physician. Routine/preventive refers to immunizations that are performed prior to the onset of signs or symptoms of illness, condition or disease, or services which are not diagnostic. Please note that immunizations which are job-related or due to employment reasons are not covered.
Below you will find a listing of eligible immunizations. An effective date may be listed beside some of the immunizations. Coverage for these immunizations is only available after the specified date. 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). Some health plans may not cover any or all of these immunizations, or may provide coverage for additional immunizations. Any variance will be noted in the Benefit Booklet.
Immunization Description | Abbreviation | Restrictions |
---|---|---|
Immunization Administration | ||
Hepatitis A | Effective date of service 03/01/2006 | |
Hepatitis A and B | Effective date of service 03/01/2006 | |
Hemophilus Influenza B Vaccine | HIB | |
Influenza Virus Vaccine | 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) | |
Pneumococcal Conjugate | PCV | |
Rotavirus Vaccine | ||
Diphtheria, Tetanus, Acellular Pertussis | DTaP | |
Diphtheria, Tetanus | DT | |
Tetanus Toxoid | ||
Mumps Virus Vaccine (Live) | ||
Measles Virus Vaccine (Live) | ||
Rubella Virus Vaccine | ||
Measles, Mumps and Rubella Vaccine | MMR | |
Measles, Mumps, Rubella, and Varicella Vaccine | MMRV | |
Poliomyelitis Vaccine | IPV | |
Adult Tetanus and Diphtheria Toxoids (Absorbed) | Td | |
Tetanus, Diphtheria, Acellular Pertussis | Tdap | |
Varicella (Chicken Pox) Vaccine | ||
Diphtheria Toxoid | ||
Diphtheria, Tetanus, Acellular Pertussis and Hemophilus Influenza B Vaccine | DTaP-Hib | |
Diphtheria, Tetanus Toxoids, Acellular Pertussis Vaccine, Hepatitis B, and Poliovirus Vaccine, Inactivated | DTaP-HepB-IPV | |
Diphtheria, Tetanus Toxoids, Acellular Pertussis Vaccine, Hemophilus Influenza Type B, and Poliovirus Vaccine, Inactivated | DTaP-Hib-IPV | Effective date of service 6/26/2008 |
Diphtheria, Tetanus Toxoids, Acellular Pertussis Vaccine and Poliovirus Vaccine, Inactivated | DTaP-IPV | Effective date of service 6/26/2008 |
Meningococcal Polysaccharide Vaccine | Effective date of service 01/01/2005 | |
Meningococcal Conjugate Vaccine | Effective date of service 09/01/2005 | |
Hepatitis B Vaccine (Active Immunizations) | HepB | |
Hepatitis B and Hemophilus Influenza B Vaccine (Active Immunization) | HepB - Hib | |
Human Papilloma Virus (types 6, 11, 16 and 18); Gardasil® | HPV | Effective date of service 09/01/2006. This is covered for females only. Effective date of service 1/08/2011. This includes males ages 9-21 years |
Human Papilloma Virus (types 16 and 18); Cervarix® | HPV | Effective date of service 12/01/2009, covered for females only, ages 10-26 |
Zoster (Shingles) Vaccine | Effective date of service 11/01/2006; Please note this vaccine is for adults 50 years of age and older or immunocompromised or immunodeficient adults 19 years of age and older based on the CDC/ACIP |