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  2. What is Eligible for Sharing?

Are wellness visits shared?

Are preventive visits shared?

Wellness Visits/Screening tests are eligible for sharing as follows:

One annual/well visit for members six years and older per membership year. Includes a $150 allowance for the following routine labs as ordered by the provider during the annual/well visit.

• Complete Blood Count with Differential and Platelets

• Comprehensive Metabolic Panel

• Lipid Profile with Lipoprotein Particle Assessment

• Hemoglobin A1C

• Vitamin D-25 OH

• C-Reactive Protein

• Fecal Occult Blood Test

• Pap Smear

• PSA 11

Members under the age of 6 receive one annual visit. Additional visits will follow routine well-child guidelines. Additional visits are not free and are subject to PRA and Co-share.

Infants and Children: Sharing for routine well-child care is eligible until the child reaches the age of six. Well-child care is defined as recommended routine check-ups and associated lab work, excluding vaccinations and/or immunizations.

 

In addition, the following cancer screening tests are eligible for sharing but are subjected to PRA and Co-share. 

  • Women: Pap test—one every three years from age 21-65 
  • Mammogram—one every year for ages 45-54, every two years starting at age 55
  • Men: PSA test—one every year, starting at age 45 
  • All: Colonoscopy—one every ten years starting at age 45 or one every five years for members at high risk

*You can use you use the $150 lab credit toward your Pap smear or PSA; however, any balance after the $150 is applied is subjected to PRA and Co-share.

*Note: Bills are processed in the order they are received to apply allowances and sharing.

*As it pertains to eligible preventive care for both men and women, both the test and coordinated office visit will be eligible for sharing.