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September 20, 2022

Currently, the federal government is purchasing monkeypox (hMPXV) vaccines. The vaccine is not covered under ACA provisions at this time, therefore standard health plan cost-shares will apply. Vaccine administration is covered under ACA provisions because vaccination administration codes are not specific to the monkeypox vaccine.

This coverage applies to plans in all states except Oregon. On Aug. 10, 2022, the Oregon Department of Consumer and Business Division of Financial Regulation (DFR) issued a bulletin reaffirming the Oregon Health Authority’s (OHA) public health declaration for insurance coverage of monkeypox vaccination in the state, retroactive to Aug. 4, 2022. For administration purposes, we are covering the vaccine and administration at 100% retroactive to August 1st.

For insurers in Oregon, coverage of the monkeypox vaccine and administration is required with no cost share regardless of the provider’s network status. Currently the federal government is purchasing the vaccine. The cost of the vaccine is unknown, though it is expected to be nominal.

This bulletin applies until the OHA declaration expires. The DFR has not set an expiration date.

We will implement coverage for members on Regence BlueCross BlueShield of Oregon fully-insured and self-funded plans at no member cost share, retroactive to Aug. 1, 2022.

Self-funded groups were asked to notify us via email by Sept. 9, 2022, if they choose to opt out of coverage at no cost share for in-network and out-of-network providers. For groups that have chosen to opt out, coverage is applicable under their standard health plan cost-shares.

Questions? Contact your account representative.