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. Coverage is provided for preventive care Services, including: 1. 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, except that the recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography and prevention issued during or around November 2009 are not considered to be current. Visit: xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx; 2. Immunizations for routine use in children, adolescents and adults that have a recommendation in effect from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) with respect to the individual involved. A recommendation from the Advisory Committee on Immunization Practices of the CDC is considered to be: in effect after it has been adopted by the director of the CDC and for routine use if it is listed on the immunization schedules of the CDC. Visit: xxx.xxx.xxx/xxxxxxxx/xxxx/XXXX; 3. 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. To see the current guidelines, visit: xxxx://xxxx.xxxx.xxx; 4. With respect to women (to the extent not described in paragraph “a” above), evidence- informed preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. To see the current guidelines, visit: xxxx://xxxx.xxxx.xxx; 5. A voluntary Health Risk Assessment that can be completed by Members annually. Written feedback provided to Members will include recommendations for addressing identified risks; 6. All United States Food and Drug Administration (FDA) approved contraceptive methods, sterilization procedures and patient education and counseling for all women with reproductive capacity; 7. Routine prenatal care; 8. BRCA counseling and genetic testing. Any follow up Medically Necessary treatment is covered at the applicable Cost Share based upon type and place of service; and 9. Medically Necessary digital tomosynthesis, commonly referred to as three-dimensional “3_D”
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. Enrollees who have current symptoms or have been diagnosed with a medical condition are not considered to require Preventive Care for that condition but instead benefits will be considered under the Diagnostic Health Services benefit. Preventive Care Services in this section shall meet requirements as determined by federal and state law. Health Services with an “A” or “B” rating from the United States Preventive Services Task Force (USPSTF) and subject to guidelines by the USPSTF.
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 Transplants Organ transplant services 0% - After deductible 40% - After deductible Physical/Occupational Therapy 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. 0% Not Covered Diabetic office visits Podiatrist services - first routine visit in a plan year $0 Not Covered Vision care services - first routine eye exam in a plan year that includes a retinal eye exam. $0 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. $20 Not Covered Retail clinics $20 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. $20 Not Covered Organ Transplants Organ transplant services 0% - After deductible Not Covered Physical/Occupational Therapy Outpatient hospital/in a physician’s/therapist’s office. 20% - After deductible Not Covered
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% 20% - After deductible Diabetic Office Visits Podiatrist Services - First routine visit in a plan year 0% 20% - After deductible Vision Care Services - first routine eye exam in a plan year that includes a retinal eye exam. 0% 20% - After deductible Hospital based clinic visits $40 20% - After deductible Pediatric clinic visit Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. Network Providers Non-network Providers (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay PCP practices with PCMH model of care $20 20% - After deductible PCP does not practice with PCMH model of care $30 20% - After deductible PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls. PCP practices with PCMH model of care $20 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. $40 20% - After deductible Office visits and house calls rendered by a behavioral health specialist. $30 20% - After deductible Organ Transplants Organ transplant services 0% - After deductible 20% - After deductible Physical/Occupational Therapy Outpatient hospital/in a physician’s/therapist’s office. 20% - 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. $0 20% - After deductible Diabetic Office Visits Podiatrist Services - First routine visit in a plan year $0 20% - After deductible Vision Care Services - first routine eye exam in a plan year that includes a retinal eye exam. $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. $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 Transplants Organ transplant services 0% - After deductible 20% - After deductible Physical/Occupational Therapy Outpatient hospital/in a physician’s/therapist’s office. 20% - After deductible 40% After deductible
Preventive Care Services. Group agrees to ensure that Group Participating PCPs render preventive care services and health improvement education to BlueLincs HMO Members during each office visit and document such in the BlueLincs HMO Member's records.
