How it works
Preventive care is 100% covered for those enrolled in the Premier Plan, Contribution Plan, Saver Plan, eCommerce PPO Plan, or a Local Plan. These services include:
- Annual checkups for all covered family members
- Immunizations for children and some adults
- Seasonal flu vaccination
- Pap tests, mammograms, colonoscopies and other screening services
- Well-woman visits and associated preventive services
- Preventive services for pregnant women
- Behavioral screening and counseling
Other plan details
Your plan covers 100% of the cost of eligible preventive care services when you see a network provider. You do not need to reach your deductible or out-of-pocket maximum to get this benefit.
If you see a network provider for a regular office visit and receive preventive care, you may have to pay coinsurance or a copay for the original purpose of the visit. For example, if you visit a doctor for an infection and get a flu shot while you’re there, you’ll still be charged for the office visit.
If you enroll in the Select Local Plan or a Local Plan and see a non-network provider, you won’t be covered.
If you’re in another plan and see a non-network provider for preventive care, you’ll pay 50% of the cost, and your payment will not apply toward your out-of-pocket maximum.
For a complete list of eligible preventive care services, see the 2020 Associate Benefits Book. This document will control in the event of any conflict.