Understanding your preventive care benefits

Even if you’re healthy and feeling good, it’s important to keep up with your preventive care. Periodic health exams, vaccines, cancer screenings and other recommended preventive care services help prevent or detect problems early on when they’re easier to treat.

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We follow recommendations from three government agencies to determine which services we cover.* When you see an in-network provider, you’ll pay nothing for the preventive services listed here. To easily find providers in your network, sign in and find a doctor.

You may be responsible for an out-of-pocket expense if:

  • You see an out-of-network provider
  • Your doctor provides preventive care outside the guidelines
  • Your provider doesn’t obtain any required pre-authorization

Some plans may have limitations or may not cover all of these services. Sign in to review your benefits.

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*These scientifically supported guidelines are created by the United States Preventive Services Task Force (USPSTF), Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).

What’s covered: Types of preventive care

Check the list below to see which preventive services most of our plans cover. Some plans may have limitations or may not cover all of these services. If you have any questions, check your benefits or call Customer Service at the number on the back of your member ID card.

Preventive care vs. diagnostic care

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Preventive care is precautionary and routine, like an annual physical.

Diagnostic care diagnoses or treats new symptoms or existing problems.

Why does it matter? When you're in network, preventive care is generally covered in full at no cost to you. Diagnostic care may come with costs like copays or deductibles.

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Your doctor wants you to get a colonoscopy. Is it preventive or diagnostic care? It depends!

Preventive colonoscopy: A screening as a precaution due to your age.

Diagnostic colonoscopy: A screening because of symptoms you're having.

If your doctor recommends a specific test or procedure, you can ask if it’s for preventive or diagnostic purposes—that way you’ll know what type of coverage to expect.