Benefits Guide
Wellness Benefits
Wellness Benefits are provided under all three PPO plans and includes:
Routine Preventive Care
- 100% coverage of in-network eligible charges with no deductible up to $750 annual maximum per covered person
- Eligible charges above $750 per covered person are payable but subject to deductible and coinsurance
Routine Preventive Care includes:
- Routine physical exams (no limit on visits)
- Routine diagnostic tests (lab and x-ray)
- Routine eye exams (includes contact lens fitting and refractions)
- Routine hearing exams
Examples of Routine Preventive Care |
|
Routine Physical Exam |
Well-Baby/Child Care |
Blood Pressure Screening |
Annual Prostate Exam |
Annual Mammogram |
Annual Fasting Blood Sugar Test |
Clinical Breast Exam |
Annual Cholesterol Test |
Annual Pap Smear |
Routine Lab (blood, urine) Testing |
Periodic Preventive Tests and Services
- Payable at 100% with no deductible and no annual maximum
Periodic Preventive Services under the Wellness Benefit are:
- Routine Sigmoidoscopy
- Routine Colonoscopy
- Bone Mineral Density
- Immunizations (excluding immunizations for foreign travel)
Wellness Benefits are not subject to age or frequency limitations.