Underinsured Clause Samples

Underinsured. A child who has health insurance, but the coverage does not include vaccines; or b) A child whose insurance does not cover all Advisory Committee on Immunization Practices (ACIP) recommended vaccines. The child would be eligible to receive those vaccines not covered by the insurance. Underinsured children are eligible to receive VFC vaccine only through a Federally Qualified Health Center (FQHC), or Rural Health Clinic (RHC) or under an approved deputization agreement. B. State Vaccine-eligible Children 1. In addition, to the extent that my state designates additional categories of children as “state vaccine- eligible,” I will screen for such eligibility as listed in the addendum to this agreement and will administer state-funded doses (including 317-funded doses) to such children. Children aged 0 through 18 years that do not meet one or more of the federal eligibility vaccine categories (VFC-eligible), are not eligible to receive VFC-purchased vaccine.

Underinsured. The patient is not Uninsured and has out-of-pocket medical costs accumulated in the past 12 months for Emergency Medical Care or other Medically Necessary Services that amount to more than 10% of the individual’s annual gross income. Uninsured: The patient has no level of health insurance or third-party assistance to assist with meeting their health care related payment obligations or the patient has exhausted their health insurance benefits and can demonstrate an inability to pay full charges based on the eligibility criteria in this Policy.

Underinsured. People whose out-of-pocket health expenses would have exceeded 10 percent of family income ("Healthcare cost and financing: working poor unlikely to receive employment-related insurance.,") or people with an inability to pay out-of- pocket health expenses despite having insurance.

Underinsured. Patients whose insurance does not provide first-dollar coverage for vaccines. This means that copays, coinsurance, or deductibles will not apply for the administration of any ACIP-recommended vaccines purchased with these funds. b) Uninsured: Patients who do not have any medical insurance coverage.

Underinsured an adult that has insurance, but the insurance: o Does not cover vaccines. o Has non-covered ACIP recommended vaccines. Only the specific vaccines that are not covered would be eligible for coverage as underinsured. o Has a cap on the coverage. The provider must have documentation that the insurance company was contacted, and the insurance cap has been reached. The documentation is required to be kept on file for a minimum of 3 years after the administration of the vaccine. B. Fully insured individuals seeking vaccines during identified public health response activities* including: 1. Outbreak response 2. Post-exposure prophylaxis 3. Disaster relief efforts 4. Mass vaccination campaigns or exercises for public health preparedness *Requires pre-approval from the Kansas Department of Health and Environment/Kansas Immunization Program (▇▇▇) prior to the use of 317-funded vaccine for the above activities.

Underinsured. A person who has health insurance, but the coverage does not include vaccines, a person whose insurance covers only selected vaccines or a person whose insurance does not provide first-dollar coverage for vaccines. 3. I will comply with immunization schedules, dosages, and contraindications that are established by the Advisory Committee on Immunization Practices (ACIP) unless: a) In the provider's medical judgment, and in accordance with accepted medical practice, the provider deems such compliance to be medically inappropriate for the person; b) The particular requirements contradict state law, including laws pertaining to religious and other exemptions. 4. I will maintain all records related to the Vaccines for Adult Program for a minimum of three years and upon request make these records available for review. Vaccines for Adult records include, but are not limited to, screening and eligibility documentation, billing records, medical records that verify receipt of vaccine, vaccine ordering records, and vaccine purchase and accountability records.

Underinsured. An adult who is covered by public or private health insurance but the coverage does not include vaccines or does not cover all Advisory Committee on Immunization Practices (ACIP) recommended vaccines. The patient would be eligible to receive any vaccines no covered by their health insurance plan. • Hepatitis B birth dose vaccine; • Influenza vaccines used in Point of Dispensing (POD) exercises; and • Vaccines needed to respond to a documented disease outbreak.

Underinsured. An adult who has health insurance, but the coverage does not include vaccines; an adult whose insurance covers only selected vaccines (VFA-eligible for non-covered vaccines only). Adults aged 19 years and older that do not meet at least one of the VFA vaccine eligibility categories are not eligible to receive VFA-purchased vaccine.