Routine preventive services FAQ
Routine preventive care benefits vary from health plan to health plan. If you have questions about your plan’s coverage, you can check your benefits. Or, call Member Services at the phone number on the back of your Member ID card for more help.
What are routine preventive services?
These services include screenings, checkups and counseling. They help prevent health problems before you have any symptoms. They do not include tests or services to monitor or manage a condition or disease once it has been diagnosed.
What’s covered under the preventive care benefit?
Depending on your health plan, these services may be covered:
- Vaccines according to The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) Immunization schedules
- Breast, cervical and colorectal cancer screenings
- Blood pressure, diabetes and cholesterol tests
- Alcohol, tobacco and weight screening
- Routine pre- and post-natal care
- Well-child visits
What’s the difference between diagnostic services and preventive services?
Diagnostic services help your provider diagnose your illness and decide on your treatment. They may even involve some tests used as preventive services. But, these services are not preventive if you get them as part of a visit to:
- Diagnose a new condition
- Monitor a condition you already have
- Treat an illness or injury
Who recommends what preventive services should be done routinely?
We use advice from The Institute for Clinical Systems Improvement, the Centers for Disease Control and the U.S. Preventive Services Task Force. These experts look at the best research when they recommend routine preventive services.
Is there a cost for routine preventive services?
These services are usually covered 100 percent. So, you may pay nothing for these services when you’re seen at a clinic in your plan’s network. If you get preventive services from an out-of-network provider, your out-of-network preventive benefit will apply. Some plans do not include coverage for preventive services outside the network. If you have questions, you can check your benefits. Or, call Member Services for more help.
What if I receive preventive and non-preventive services in the same office visit?
You can have preventive and non-preventive services in the same office visit. For example, you may visit your doctor for a Pap screening to check for cervical cancer (preventive care). In the same visit you may wish to discuss a health concern (non-preventive care). Your office visit benefit may apply to the non-preventive part of your visit.
Talk to your doctor about what preventive services are best for you.