Preventive care

All three available medical coverage options — PPO, EPO, and HDHP — provide an annual preventive care benefit for you and your enrolled family members.* There is no cost to you when using network providers for the following: 

• yearly well visits with your primary care physician
• annual well-woman visits with your gynecologist 
• health screenings and immunizations listed on the Preventive Schedule 
• additional specified screenings and immunizations for internationally adopted children up to age 18 

For a service to be considered preventive, you must go to the doctor without signs or symptoms of illness for the annual exams, tests, and immunizations specified by the plan for your age and gender.

Preparing for your well visit

Make the most of your well visit. Before you go, do the following:

• Confirm that your doctor is a network provider by
• calling the Member Services number on the back of your medical ID card; 
• using the provider search tool on your service provider’s website; or
• contacting your doctor’s office.
• Review the Preventive Schedule to see which screenings and immunizations you qualify for based on your age and gender.
• Make a list of any questions you have and bring them with you to your appointment.

If the doctor diagnoses a condition

Your well visit is covered under the preventive care benefit even if your doctor diagnoses a health condition during your exam. For any subsequent care related to that health condition or for tests that are not listed on the Preventive Schedule, you must pay the applicable copay, deductibles, and/or 20 percent copayments.

If you think a claim for a preventive service was processed incorrectly, call your service provider. If you need more assistance, call the Board of Pensions at 800-773-7752 (800-PRESPLAN) and speak with a service representative.

*Those enrolled in Triple-S, GeoBlue, or the Medicare Supplement Plan also have preventive care benefits under their plans, but coverage details may differ. Consult your plan’s provisions for details.