CommercialCoverageLow impact
Promoting the flu vaccine
Harvard Pilgrim Health Care·Provider Newsletter
We identified it
Jun 26, 2026
Summary
This is an informational policy from Point32Health (Harvard Pilgrim and Tufts Health Plan) promoting flu vaccine administration and coverage. It clarifies that Harvard Pilgrim covers flu vaccines at $0 cost share for commercial members ages 3+, and most Tufts Health Plan products cover flu shots at no cost with reimbursement available for out-of-pocket payments. The policy emphasizes provider responsibility in patient education about flu vaccination and references HEDIS measures for pregnant patient immunization tracking.
Action Required
No immediate billing changes required. This is a provider education and coverage clarification notice. Billing team should: (1) Confirm that flu vaccine claims for Harvard Pilgrim commercial members ages 3+ are billed with $0 patient cost share; (2) For Tufts Health Plan members, process flu vaccine claims as covered benefits at no cost and accept reimbursement requests for out-of-pocket payments; (3) Direct patients unsure about coverage to call Member Services. No workflow modifications or system updates are necessary at this time.