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.