Your NALC Health Benefit Plan includes coverage for childhood vaccines as recommended by the CDC, at no cost when you use in-network providers. No copay, no deductible. It is one of the most straightforward benefits in your plan, and one of the most valuable for families with young children.
This article covers what your plan includes for childhood vaccines, how to use your benefits, and what to do if life has made it hard to stay on track. Falling a little behind is not the same as falling short, and your plan is ready to support you either way.
What your NALC HBP covers for Childhood Vaccines
NALC HBP covers childhood vaccines as recommended by the CDC at 100% when administered by an in-network provider. That means no out-of-pocket cost when you stay in-network. No copay, no deductible, no cost-sharing. For the complete current schedule, visit the CDC immunization schedule.
Vaccines can also be given at participating pharmacies in the Broad Vaccine Administration Network at no cost. When NALC HBP is the primary payor, the plan covers FDA-approved vaccines administered at any pharmacy that participates in this network. Call CVS Caremark Customer Service at 800-933-NALC (6252) to locate a local participating pharmacy.
If you go out of network, cost-sharing applies:
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High Option: 35% coinsurance of the plan allowance, plus any difference between the provider's charge and what the plan allows (calendar year deductible applies).
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CDHP: 50% coinsurance after your calendar-year deductible, plus any difference between the provider's charge and what the plan allows (calendar year deductible applies).
One important note for CDHP members: in-network preventive vaccines are covered at no cost. They don't require you to first exhaust your Personal Care Account (PCA) balance or meet your deductible.
Well-Child Visits: Your Coverage by Age
In-network well-child visits are covered at no cost from birth through age 21, they're the routine appointments where vaccines are typically reviewed and given. The benefit breaks down by age:
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Birth through age 2: In-network routine well-child visits are covered at 100%
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Ages 3–21: In-network annual physicals are covered at 100%, including school, camp, and sports physicals — except when performed at a CVS MinuteClinic® location
Completing 6 well-child visits through your child's first 15 months also earns a wellness reward: $50 for High Option members and $30 for CDHP members.
Why staying on track matters and what to do when life gets in the way
Recommended vaccine schedules are designed to give children protection at the ages when they need it most. But parenting is busy, schedules shift, and appointments get missed. If that has happened in your family, you are far from alone, and it does not mean you need to start over.
If your child has missed vaccines, the most important thing is simply to pick it back up. A provider can help you figure out where your child left off and put together a catch-up plan that fits their age and health history. Vaccines do not need to be restarted from scratch, and a small gap does not undo the protection your child already has.
At the same time, there is no need to rush. Some parents feel anxious when they realize their child is behind and try to get everything done at once. That urgency is understandable, but it is not necessary. A calm conversation with your child's provider is all it takes to get back on track in a way that works for your family.
Your provider is your best resource for questions about timing, catch-up, or anything you are unsure about.
How to use your NALC HBP coverage for your Child's Vaccines
Getting your child vaccinated through your plan is straightforward. Here is how it works:
Find an in-network provider. Use the Cigna provider directory or visit mycigna.com, to locate in-network providers and pediatricians near you.
Schedule well-child visits. These are covered at no cost in-network from birth through age 21. They're also the best opportunity to talk with your provider about your child's vaccination history and any questions you have.
Consider in-network pharmacies. Vaccines are available at no cost through participating pharmacies in the Broad Vaccine Administration Network. High Option and CDHP member can call CVS Caremark at 800-933-NALC (6252) or visit caremark.com
Vaccines for Adults — Your Coverage Includes You Too
Vaccine coverage through NALC HBP isn't just for children. Adult members also have coverage for vaccines as recommended by the CDC, including annual flu and pneumococcal vaccines, at no cost with in-network providers.
Both the flu vaccine and the pneumococcal vaccine each earn their own wellness reward through the Postal Wellness Rewards Program: $10 per vaccine for High Option members, $5 per vaccine for CDHP members.
Frequently Asked Questions
Are childhood vaccines covered at no cost under my NALC HBP plan?
Yes. FDA-approved vaccines as recommended by the CDC are covered at 100% when administered by an in-network provider or a participating pharmacy in the Broad Vaccine Administration Network. No copay, no deductible. CDHP members: this applies before and independent of your PCA balance.
Which vaccines are covered for children?
The plan covers immunizations recommended by the CDC, including DTaP/Tdap, Polio, MMR, and Varicella, among others. For the full and current list, visit the CDC immunization schedule. The plan follows CDC recommendations, which are reviewed annually.
What if my child missed some vaccines? Is it too late to catch up?
No. Talk to your child's provider about where things stand. They can put together a catch-up plan suited to your child's age and health history without restarting from scratch.
Where can I find an in-network provider for vaccines?
Visit the find coverage page or visit mycigna.com. Vaccines given at participating pharmacies in the Broad Vaccine Administration Network are also covered at no cost.
Are annual physicals for school, camp, or sports covered?
Yes. Annual physicals for ages 3 to 21 are covered at no cost in-network, including school, camp, and sports physicals — except when performed at a CVS MinuteClinic® location.
Do well-child visits count toward wellness rewards?
Yes. Completing 6 well-child visits through age 15 months earns a reward: $50 for High Option members and $30 for CDHP members. Annual flu and pneumococcal vaccines each earn their own separate reward too. See the wellness rewards page for everything that qualifies.
Questions?
Contact our Customer Service Department at 888-636-6252, Monday through Friday, 8:00 a.m. to 6:00 p.m. Eastern.
