Preventive Care and Wellness
The Plan covers a comprehensive list of wellness and preventive care services to keep you and your family healthy.
Preventive care is covered at 100% of the contracted rate when you visit a PPO provider (or if you are considered out-of-area), with no deductible required. If you visit an out-of-network provider, benefits are payable at 75% of the UCR rate.
Covered preventive and wellness services provided by the Plan closely follow current recommendations of the United States Preventive Services Task Force (USPSTF), the Health Resources and Services Administration, the American Academy of Pediatrics, Bright Futures, and the Centers for Disease Control and Prevention. These websites list the types of preventive services (such as well child visits, immunizations, mammogram, Pap test, colonoscopy with polyp removal) that are covered by the plan:
- U.S. Preventive Services Task Force Recommendations
- Preventive Care Benefits recommended by Healthcare.gov
- Health Resources & Services Administration Women’s Preventive Services Guidelines
In addition to the wellness services listed on the websites above, the Plan will pay for these services:
- Annual wellness physical exam for adults
- Prostate-specific antigen (PSA) lab test for men age 40 or older
- Glaucoma screening
- Thyroid test
- Complete blood count
- Urinalysis
- EKG
Certain additional preventive care is payable for covered females, including but not limited to:
- Well-woman office visit
- Screening for gestational diabetes
- BRCA breast cancer gene test
- HPV testing at least every three years starting at age 30
- Counseling on sexually transmitted infections
- Annual HIV screening and counseling
- Rental of breastfeeding equipment and necessary supplies after delivery, with lactation support following delivery
