MedicaidCoverageMedium impact
20-931 Give Timely Flu Shots to Help Keep Members Healthy
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net confirms flu vaccines are covered as essential preventive benefits without prior authorization or member cost-sharing. Providers must ensure timely access and may refer members to alternative sites when vaccines are unavailable, with delegated PPGs responsible for covering out-of-network costs during COVID-19 emergency.
Action Required
Immediately: Ensure flu vaccine administration claims are submitted without prior authorization requests. Billing team must verify member eligibility and coverage details through Health Net's provider portal before administering vaccines. When referring members to out-of-network locations, coordinate with delegated PPGs to arrange coverage of costs to avoid member out-of-pocket expenses. Update encounter forms to remind providers they can offer flu vaccines during any appointment without authorization.