COVA HealthAware Flu Shot Program FAQs

A1. Participating retail pharmacy chains and independents include a number of national pharmacy and grocery store chains. Even though a pharmacy chain is on the list, every local Virginia pharmacy in that chain may not be participating. Be sure to call your local pharmacy to find out if it is participating in the Commonwealth of Virginia flu shot program and when you may schedule a flu shot. Also see the Anthem Pharmacy/CarelonRx participating pharmacy list. Check often for updates since the list may change.

A2. Use anthem.com to find in-network flu shot pharmacies. Log-in to anthem.com. Go to Find Care and select Pharmacy. Under Features, check Flu shot to filter the in-network pharmacies giving flu shots in your area.

A3. If you get a flu shot at a non-participating pharmacy, you will have to file a paper claim and may be required to pay the difference between Anthem Pharmacy/CarelonRx’s allowable charge and the pharmacy’s charge for the flu shot.

A4. Log in to your Aetna member website or use the Find a Provider link at https://www.covahealthaware.com/ to identify participating providers—just enter a convenient city and state, or zip code, and then search for flu shot. Click on “Find a Flu Shot and Vaccine Provider” to find participating providers and walk-in clinics that can provide a flu shot. When you click on providers, you will get additional information regarding their specific processes. For some, you can even schedule an appointment online. Remember, not all providers can administer the vaccine, so be sure that administration is available and that there is an adequate supply of the vaccine. Contact the specific provider to confirm availability.

A5. Coverage will be at the out-of-network benefit level; you will likely have to file the claim yourself; and, like any out-of-network provider, you may be balance billed for costs over the allowable charge.

A6. Capitol Square Healthcare will provide free regular and high dose flu shots onsite for state health plan members beginning in October. Appointments can be made at https://www.capitolsquarehealthcare.com/ or by calling (804) 628-6501 (walk-ins are not accepted). COVA Care, COVA HDHP and COVA HealthAware members will receive a flu shot at no cost. Other plan members, wage employees and those without state health coverage will pay the actual cost of the vaccine.

A7. Yes, use the Find a Provider function to identify walk-in clinics, such as Minute Clinics, that participate in the Aetna network.

A8. Yes, COVA HealthAware will pay 100 percent for flu shots administered at participating physicians’ offices. However, your doctor may charge for the office visit.

A9. COVA HealthAware participants can get flu shots at participating provider locations as soon as the vaccine is available. Flu shots should remain available for the duration of the flu season.

A10. Be sure that you and covered family members present a photo ID and your health plan ID card at the pharmacy or clinic counter so that your eligibility can be confirmed.

A11. Be sure to ask whether the flu shot clinics are being done by the participating pharmacy or a third-party vendor. To be covered at no cost to you, a flu shot must be administered through the participating pharmacy and processed by the participating pharmacy online under the Anthem pharmacy benefit. Be sure to check before getting the flu shot to ensure that the pharmacy or clinic will not charge you. If you are a COVA HealthAware participant and the participating pharmacy will not process your flu shot for free, direct them to Anthem Pharmacy/CarelonRx at the number on your ID card.

A12. This will vary by provider. Contact the provider in advance to be sure you understand the process. Some providers allow on-line scheduling (see question 1).

A13. These providers are not limited to the state program.

A14. Children under 18 may need a prescription to get a flu shot at a pharmacy. However, depending on the pharmacy, the pharmacist can call the doctor for a prescription. Parents should call ahead to find out if the pharmacy will dispense a flu shot to children and to inquire if the pharmacy has an age limit.

A15. Eligible employees, retirees and their spouses can receive an HRA “Do Right” incentive for getting an annual flu shot. If you receive the flu shot:

• Through a participating provider, the incentive will automatically be applied to your HRA within the month after Aetna receives and processes the claim.
• Through a participating pharmacy, the incentive will automatically be applied to your HRA within the month after Anthem Pharmacy receives and processes the claim and provides the information to Aetna.
• At an on-site clinic sponsored by your employer, be sure the provider or pharmacy is collecting your ID card information in order to submit a claim to the health plan.
• Through another program or clinic where your ID card information is not collected and no claim will be submitted to the health plan, you can complete and submit the Flu Shot Incentive Form.

A16. The senior high dose flu shot is available for members ages 65 and older. It is also recommended for diabetics and others with certain chronic conditions.

A17. In line with federal Centers for Disease Control recommendations, the flu shot program will cover the FluMist vaccine during the 2025-2026 flu season.

A18. Visit the CDC website for the latest information regarding flu shot coadministration.