Who is an “underinsured individual” for purposes of requesting reimbursement for vaccine administration?

The HRSA COVID-19 Coverage Assistance Fund reimburses providers for COVID-19 vaccine administration services provided to an individual who has a health plan that either does not include COVID-19 vaccine administration as a covered benefit or covers COVID-19 vaccine administration but with cost-sharing. Section 3203 of the CARES Act generally requires non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage to cover any qualifying coronavirus preventive service, including recommended COVID-19 vaccines and their administration, without imposing any cost-sharing requirements, such as a copayment for vaccine administration, co-insurance, or deductible for vaccine administration. However, these coverage requirements do not apply to a plan or coverage that is not required to provide coverage of preventive services without cost-sharing under section 2713 of the Public Health Service Act, such as grandfathered group health plans, excepted benefits, and short-term limited duration insurance.