5.13 PREVENTIVE HEALTH CARE
Preventive care is covered 100% (subject to UCR limits), with no copayment or deductible. Preventive care means those services and supplies designed as “preventive care” under the Health Care Reform law, and which the Plan is required by law to provide.
Covered preventive care may be different depending on your age, gender and circumstances. Here are some examples of common services that (depending on your age, gender and circumstances) are covered preventive care:
- Routine physical exams
- Cholesterol screenings
- Pap smears
- Obesity screening
- Blood pressure screening
- Type 2 Diabetes screening
- Immunizations (as recommended by the Centers for Disease Control and Prevention)
- Newborn Hearing exam
- Pediatric oral and vision screening
- Tobacco cessation programs
The schedules of preventive care services are available at www.hhs.gov/healthcare/prevention and www.cdc.gov/vaccines/schedules/index.html, or from the Trust Office. Be sure to check the schedules before you access services because some services are not covered for all ages, and some have coverage limits. Also note that the Plan may use reasonable medical management techniques, such as location for service or test frequency, to determine covered preventive care.
When both preventive care and diagnostic or therapeutic services occur at the same visit, you generally pay the cost share for the diagnostic or therapeutic services but not for the preventive care.
Preventive care drugs and supplements are covered under the Prescription Drug Benefit, and only if prescribed.