Preventive care can help us stay well and detect conditions early, when they are easier to treat.
All three 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:
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.
Make the most of your well visit. Before you go, do the following:
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 coinsurance (previously referred to as 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).
The Board follows the recommendations of the U.S. Preventive Services Task Force. If a provider conducts tests or services beyond those recommendations, they are considered to be beyond the scope of the preventive care benefit and subject to regular plan provisions (i.e., deductibles, copays, and/or coinsurance). For example, some providers perform routine electrocardiograms (EKGs) during preventive exams; coverage for this test would be subject to regular plan provisions.
If you’re enrolled in the PPO medical option and see an out-of-network provider for preventive care when a network provider is available, the plan pays 50 percent of the plan allowance for preventive office visits, with no deductible, and you pay the remaining 50 percent plus any charges above the allowed amounts. Blood work, screenings, and tests listed on the Preventive Schedule (for your age and gender) are covered at 100 percent.
To find network providers, call the number on the back of your medical ID card or visit your service provider’s website.
Note: The EPO and HDHP do not cover preventive care services received from out-of-network providers.
If you have medical coverage* through the Board of Pensions, you can take advantage of a benefit designed to meet the unique health needs of children adopted from other countries. This benefit is available for children through age 18 and includes the following:
See Guide to Your Healthcare Benefits for more information, including a detailed list of recommended health screenings for internationally adopted children.
*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.