Preventive care

By providing enhanced preventive care benefits, the Board of Pensions encourages all Medical Plan members to get regular preventive examinations and be proactive about their physical well-being. Preventive approaches reduce healthcare costs, improve medical outcomes, and can even save lives.​

couple with child

If you are enrolled in one of the three Medical Plan options (PPO, EPO, or HDHP), your coverage provides an annual preventive care benefit:

  • $0 copay for yearly well visits with your primary care physician
  • $0 copay for annual well-woman visits with your gynecologist
  • certain health screenings and immunizations at no cost to you

Eligibility

To qualify for preventive care benefits, you must

  • be an active member or eligible family member covered by the Medical Plan* (includes active, disabled, and continuation members and those members with transitional participation coverage); and
  • 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.

If a health condition is diagnosed during the exam, the visit still qualifies for preventive care coverage.

*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.

Costs

Costs for preventive care services are as follows:

Preventive care servicePlan paysYou pay
Annual well visit with a network providerPlan pays 100 percent for the visit$0
Annual well visit with an out-of-network provider

PPO: Plan pays 50 percent of the plan allowance for the visit
EPO: Not covered

HDHP: Not covered

PPO: the balance
EPO: 100 percent

HDHP: 100 percent

Scheduled preventive care screenings, tests, and immunizationsPlan pays 100 percent of plan allowance$0

 

If your provider conducts tests or services that are not listed on the Preventive Schedule, they are subject to normal plan provisions (i.e., deductible and copayment rules apply to covered tests and services).

Call to Health

​You can improve your well-being and earn reduced deductibles by answering the Call to Health.

Read more