What is Preventive Care?

Prevention care doctor talking to patient

The right preventive care at every stage of life can help you stay healthy, avoid or delay the onset of disease, or keep a condition you may already have from becoming worse. Adults and children need routine immunizations, screenings and preventive check-ups. Our preventive services guidelines describe the recommended preventive services. Depending on your personal health care needs or risk factors, your doctor may advise a different schedule. Talk to your doctor about what health screenings are right for you or your family members.

Determine which screenings or immunizations may be appropriate for you.

What is not Considered Preventive Care

Your doctor may order tests during your preventive care visit that are covered under your plan’s medical benefits, not your preventive care benefits. Your doctor may also treat an existing condition (or you may have symptoms of an illness at the time of your visit). These tests and/or treatments may be subject to deductibles, copays and/or coinsurance.

Member Example

Kelly, age 45, sees her doctor for her routine office visit and has age appropriate screenings during her annual physical. Her doctor orders a lipid screening, urinalysis and full blood chemistry panel. The office visit and the lipid screening, recommended by the United States Preventive Services Task Force (USPSTF), are covered under the 100% preventive benefit.

However, the urinalysis and full blood chemistry panel are not paid as preventive. They are covered under the medical benefit as outlined by Kelly’s medical plan design so she would be subject to any copay/deductible/coinsurance under her plan. Why? These services are not recommended as preventive services as outlined by the USPSTF.