Does your group insurance plan cover vaccines?

Vaccines are effective in preventing infectious diseases, but whether their cost is reimbursed or not varies from case to case, and it can sometimes be difficult to understand the coverage offered by private or public insurance plans. Let’s try to unravel the issue!

The coverage that public plans offer for vaccines varies depending on province and age. As the below table illustrates, some vaccines are covered only for children, while others are offered to older adults.

In the private sector, plan sponsors choose whether or not to add vaccines to their drug coverage to complement the coverage offered under public plans. Such coverage is therefore optional under private plans.

According to our databases¹, 61% of Canadian plans include vaccines in their drug coverage. This is a small percentage compared to their preventive potential, which is on par with the benefits of other drugs reimbursed by all private group insurance plans.

Is there a disparity in the importance afforded to different conditions? Why shouldn’t shingles or HPV vaccines be reimbursed in the same way as statins, which help lower cholesterol and prevent more serious complications, such as heart attacks, and their associated costs?

To ensure equity, group insurance plans could include coverage for vaccines. This would promote access to health care for all and help reduce absenteeism and health care costs in the long term. For the purpose of managing group insurance plan costs, the addition of vaccine coverage as a preventive tool could be funded through cost-control measures such as per prescription deductibles.

In 2023, the approximate costs per dose for the most frequently claimed vaccines in Canadian group insurance plans were as follows:

When covered, vaccines represent on average between 0.5% and 1% of health insurance premiums.

Facilitating access to vaccines benefits individual health and is a strategic investment for organizations. By supporting full vaccination coverage through vaccine reimbursement, private insurance plans help reduce absenteeism and health care costs in the long term. At Normandin Beaudry, we believe that health equity is an achievable goal and a collective responsibility. With this in mind, we invite the parties concerned to consider integrating vaccination coverage into group insurance plans.

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¹ Normandin Beaudry databases for 2024, for non-unionized employees

Would you like guidance or advice on adding vaccines to your group insurance plan? Contact your Normandin Beaudry consultant or email us.