Preventive Care Services. In addition to the benefits otherwise provided in this Certificate, (and notwith standing anything in your Certificate to the contrary), the following preventive care services will be considered Covered Services when ordered by your Primary Care Physician or Woman's Principal Health Care Provider and will not be sub ject to any deductible, Coinsurance, Copayment or benefit dollar maximum:
Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services, inclusive of current recommendations for breast cancer, that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note that recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography and prevention issued in or around November 2009 are not considered to be current. • Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. • Prostate cancer screening including digital rectal exams and prostate-specific antigen (PSA) blood tests for: ▪ Male Covered Persons who are between the ages of 40 and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancer. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a voluntary basis; and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessment. Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxx...
Preventive Care Services. Physician office services None Yes No Lab, X-ray or other preventive tests None Yes No Breast pumps None Yes No
Preventive Care Services. Preventive Care Services include, Outpatient services and Office Services. Screenings and other Health Services are Covered as Preventive Care for adults and children with no current symptoms or prior history of a medical condition associated with that screening or service.
Preventive Care Services. See Prevention and Early Detection Services for coverage of annual preventive office visits.) Allergy injections - Applies to injection only, including administration. 0% - After deductible 40% - After deductible Hospital based clinic visits 0% - After deductible 40% - After deductible Pediatric clinic visits 0% - After deductible 40% - After deductible PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls and pediatric clinic visits. 0% - After deductible 40% - After deductible Retail clinics 0% - After deductible 40% - After deductible Specialists Office visits and house calls rendered by a specialist (other than a behavioral health specialist). Specialist includes but is not limited to allergists, dermatologists and podiatrists. 0% - After deductible 40% - After deductible Office visits and house calls rendered by a behavioral health specialist. 0% - After deductible 40% - After deductible Organ transplant services 0% - After deductible 40% - After deductible Outpatient hospital/in a physician’s/therapist’s office. 0% - After deductible 40% - After deductible
Preventive Care Services. See Prevention and Early Detection Services for coverage of annual preventive office visits.) Allergy injections - Applies to injection only, including administration. 10% - After deductible Not Covered Hospital based clinic visits $30 Not Covered PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls and pediatric clinic visits. PCP practices with PCMH model of care $15 Not Covered PCP does not practice with PCMH model of care $25 Not Covered Retail clinics $30 Not Covered Specialists Office visits and house calls rendered by a specialist (other than a behavioral health specialist). Specialist includes but is not limited to allergists, dermatologists and podiatrists. $30 Not Covered Office visits and house calls rendered by a behavioral health specialist. $25 Not Covered Organ transplant services 10% - After deductible Not Covered Outpatient hospital/in a physician’s/therapist’s office. 10% - After deductible Not Covered
Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force (xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx), including screening colonoscopy or sigmoidoscopy. • Immunizations for: (i) routine childhood immunizations for residents of the commonwealth; and (ii) immunizations for residents of the commonwealth who are 19 years of age and older according to the most recent schedules recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC)(xxx.xxx.xxx). • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (xxx.xxxx.xxx), including screening for lead poisoning. For purposes of this Benefit, "preventive care services" means physician's office services rendered to an Enrolled Dependent child from the date of birth through the attainment of six years of age, including physical exam, history, measurements, sensory screening, neuropsychiatric evaluation and development screening assessments at the following intervals: six times during the child's first year after birth; three times during the next year; and annually thereafter until age six. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA)(xxx.xxxx.xxx). Benefits defined under the Health Resources and Services Administration (HRSA) requirement include: • Lactation counseling and education services to ensure the successful initiation and maintenance of breastfeeding. Contact us at xxx.xxxxx.xxx or the telephone number on your ID card, or ask your Primary Care Physician, if you have any questions or need assistance locating a provider for these services. • One breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physic...
Preventive Care Services. The coverage described below shall be consistent with the requirements of the Affordable Care Act (ACA).
Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. • Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. Contraceptive devices, including the insertion or removal of, and any Medically Necessary consultations, examinations, or procedures associated with, the use of intrauterine devices, diaphragms, injectable contraceptives, and implanted hormonal contraceptives. Benefits include voluntary female sterilization and associated anesthesia. Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxxx or the telephone number on your ID card. If more than one breast pump can meet your needs, Benefits are available only for the most cost-effective pump. We will determine the following: • Which pump is the most cost-effective. • Whether the pump should be purchased or rented (and the duration of any rental). • Timing of purchase or rental. SAMPLE
Preventive Care Services. See Prevention and Early Detection Services for coverage of annual preventive officevisits.) Allergy injections - applies to injection only, including administration. 0% 20% - After deductible Hospital based clinic visits $50 20% - After deductible PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls and pediatric clinic visits. PCP practices with PCMH model of care $0 20% - After deductible PCP does not practice with PCMH model of care $30 20% - After deductible Retail clinics $30 20% - After deductible Specialists Office visits and house calls rendered by a specialist (other than a behavioral health specialist). Specialist includes but is not limited to allergists, dermatologists and podiatrists. $50 20% - After deductible Office visits and house calls rendered by a behavioral health specialist. $30 20% - After deductible Organ transplantservices 0% - After deductible 20% - After deductible Outpatient hospital/in a physician’s/therapist’s office. Limited to 30 physical therapy visits and 30 occupational therapy visits per plan year. 20% - After deductible 20% - After deductible Pre-natal, delivery, and postpartumservices. 0% - After deductible 20% - After deductible Covered Benefits- See Covered Healthcare Services for additionalbenefit limitsand details. Care Coordinated by Your Primary Care Provider and permitted Self-Referrals Flex Plan Prescription drugs and diabetic equipmentand supplies dispensed at a pharmacy. See Summary of Pharmacy Benefits for prescription drugs purchased ata retail, specialty, or mail order pharmacy. Prescription drugs dispensed and administered by a licensed health care provider (other than a pharmacist), and not purchased froma retail, specialty or mail order pharmacy: Injectable drugs* 0% - After deductible 20% - After deductible Infused drugs* 0% - After deductible 20% - After deductible Medications other than injected and infused drugs* Are included in the allowance for the medical service being rendered. Are included in the allowance for the medical service being rendered.
