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.
If you are enrolled in one of the three Medical Plan options (PPO, EPO, or HDHP), your coverage provides an annual preventive care benefit:
To qualify for preventive care benefits, you must
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 for preventive care services are as follows:
|Preventive care service||Plan pays||You pay|
|Annual well visit with a network provider||Plan 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
HDHP: Not covered
PPO: the balance
HDHP: 100 percent
|Scheduled preventive care screenings, tests, and immunizations||Plan 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).