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Preventive Services

Enjoy 100% coverage on preventive care1

Preventive care at every stage of life helps you stay healthy. Your plan covers preventive care visits at no cost when you see a network provider. During your visit, your doctor will review your health history and may recommend preventive screenings, depending on your age and risk factors.

Annual checkups can help doctors spot a health condition before it becomes serious, so don’t delay. Complete your wellness visits every year. If you need help finding a provider, search our online provider directory or call Member Services at 1-800-888-2264, TTY 711.

Your preventive benefits cover:

For examples of what counts
as preventive care — and what doesn't — click here.

Stay one step ahead of disease

Chronic diseases, such as heart disease, cancer and diabetes, are the leading causes of death and disability in the United States.2 But they don’t have to be! Schedule your preventive care screenings every year.

Regular screening, beginning at age 45, is the key to preventing colorectal cancer or finding it early.

Of the cancers affecting both men and women, colorectal cancer (cancer of the colon and rectum) is the second leading cancer killer in the United States.2 Screenings, such as colonoscopies, can find abnormal growths so doctors can remove them before they turn into cancer.

Women have the choice to get an annual mammogram beginning at age 40.

About 1 in 8 U.S. women will get breast cancer during her life.2 A mammogram (an X-ray of the breast) is the best way to detect breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms.

Cervical cancer screening should start at age 21.

Each year in the U.S., about 13,000 new cases of cervical cancer are diagnosed and about 4,000 women die of this cancer.2 All women who are sexually active or between the ages of 21 and 65 should get a pelvic exam and Pap smear (test) once every year. If a Pap test result is normal, the doctor may suggest waiting three years until the next one. A Pap test looks for precancer cell that might become cervical cancer if they’re left untreated.

Vaccines (shots) help protect against illnesses and potentially serious diseases.

A yearly flu shot is the best way to protect against the flu. The Centers for Disease Control and Prevention (CDC) recommends everyone get a flu shot every year in the fall, starting at 6 months old. Some children 6 months through 8 years of age may need two doses for best protection. The flu can be a very serious illness. People with the flu may be able to infect others one day before they get sick and up to seven days after.

Examples of what counts as preventive care — and what doesn’t

Joe visits his doctor, who is in network, for an annual wellness exam and screening blood tests. Based on their conversation, the doctor also orders additional tests to check for anemia, kidney function and liver function.

Some of the lab work ordered during a preventive care visit, like a cholesterol screening, may be covered. But other blood tests like anemia, kidney function and liver function screenings are considered diagnostic (not preventive) and would not be covered. Joe would pay for the costs of these diagnostic tests.

Jane decides to get flu shots for herself and her son Josh. Because she doesn’t have a regular doctor, she goes to a nearby hospital and visits the emergency department. A nurse on duty gives flu shots to Jane and Josh.

The flu shots for Jane and Josh are considered preventive care and are covered by the health plan. But the visit to the hospital emergency department to get the flu shot is not covered. Jane would be responsible for paying the charge for going to the emergency department.

John visits his primary care doctor, who is in network, for his preventive care exam. Based on his age, his doctor recommends a screening colonoscopy.

This is considered preventive care because this service is part of a routine annual exam and has not been prompted by any sort of previous diagnosis.

Maria visits her doctor, who is in network, for her annual wellness checkup. Her doctor has concerns that she may have a serious illness. He refers Maria to a specialist and suggests that she see the doctor immediately. Maria visits the specialist and is diagnosed with a serious illness.

The office visit fee for Maria’s annual wellness checkup is covered by the health plan. But her visit to the specialist and any tests ordered by the specialist are not covered. Any subsequent treatment for the serious illness is also not covered under the preventive benefit.

Want to know more? View our preventive services guidelines.

 

1Certain preventive care items and services, including immunizations, are provided as specified by applicable law, including the Patient Protection and Affordable Care Act (ACA), with no cost-sharing to you (subject to change). These services may be based on your age, other health factors and FDA approval. Other routine services may be covered under your plan, and some plans may require copayments, coinsurance or deductibles for these benefits. Always review your benefit plan documents to determine your specific coverage details.

2CDC.gov

The content provided is for informational purposes only, and does not constitute medical advice. Always consult your doctor before making any decisions about medical care. The services outlined here do not necessarily reflect the services, vaccines, screenings or tests that will be covered under your benefit plan. Always refer to your plan documents for specific benefit coverage and limitations or call the toll-free member phone number on your health plan ID card. Certain procedures may not be fully covered under some benefit plans.