Preventive Care

Routine preventive care is an important step to staying healthy and is generally covered at 100% by most of our health plans. Examples of preventive care services include:

  • Annual check-ups
  • Screenings
  • Immunizations
  • Counseling

These preventive measures can help you and your family avoid developing health problems and prevent minor issues from becoming major health concerns such as diabetes and colon cancer.

Annual Exams

Each year you should visit with your doctor and discuss your concerns, family history and current issues. This is an important step in early detection for any age.

TIP: Summer months are typically the hardest months to get a check-up appointment scheduled. Try scheduling your check up before May or after August.

Understand the difference between preventive and diagnostic

Preventive care includes routine well exams, screenings and immunization intended to prevent or avoid illness or other health problems.

Diagnostic care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose them.

Preventive Health Guidelines - pdf

Cancer Screenings

Most preventive screenings are covered at 100% when in-network providers are used. The information below is a helpful guide on when you should be getting screened. Check with your doctor to see if you should schedule your screenings earlier or more often than recommended below.

BREAST CANCER

Starting at age 40, women should get a mammogram each year; earlier or more often if recommended by your doctor.

COLORECTAL CANCER

Screenings include colonoscopies, sigmoidoscopies, proctosigmoidoscopies, barium enemas, fecal occult blood testing, Fit DNA (once every three years) and other related services. Recommended each year starting at age 50, with fecal occult blood test or a flexible sigmoidoscopy every five years; earlier or more often if recommended by your doctor.

For more information, view our Colorectal Cancer Screening frequently asked questions.

CERVICAL CANCER

Pap test every three years for women 21 to 65. Over 65, as recommended by your doctor. Human Papillomavirus (HPV) test every three years starting at age 30.

LUNG CANCER

Screenings are recommended each year for adults age 55 – 80, who have either a 30-pack-a-year history of smoking, currently smoke or have quit within the past 15 years. Preauthorization is required.

Women's Services

 

These preventive guidelines are based on national recommendations. Please review your plan documents for coverage information.

To find out what’s covered at 100%, please call the Member Services number on the back of your ID card.

Preventive Benefits

HEALTH INSURANCE TERMS


COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy


in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.