Network preventive care services are covered at 100% in the Premier, Contribution, Saver, or Local plans. This means that if you see a doctor in your plan’s network for specific preventive services, you pay nothing, and you don’t even need to reach your plan’s deductible first.
If you choose a doctor outside the network, in most locations you’ll pay 50% of the cost in the Premier, Contribution, or Saver plans.
- If you’re in one of the plans above and you work in northwest Arkansas, or if you’re in a Local plan anywhere, there’s no out-of-network coverage except in an emergency.
- If you’re in one of the plans above in central Florida, you’ll pay 50% of the cost.
- If you’re in one of these plans in Dallas/Fort Worth, Texas, you’ll pay 50% for a non-preferred, network doctor, but you’ll have no out-of-network coverage except in an emergency.
Other office visits
If you see a network doctor for something else, and also receive preventive care during the visit, those services are 100% covered—but you’ll still have to pay your copay or coinsurance for the original purpose of the visit.
If you’re in an HMO plan, see your plan’s website or other information for preventive care coverage.