Preventive Care Coverage

A yearly wellness visit with your primary care provider or family doctor is vital for long-term wellness. And with most of our health plans, yearly wellness exams and immunizations are covered 100% for providers in our network. Here’s how to make sure you get free wellness exams and preventive care.

1. Make sure you visit an in-network provider.
2. Learn about coverage for specific preventive services:
   • Covered preventive services (in English) (pdf) | Servicios preventivos cubiertos (en Español) (pdf)
   • Recommended immunizations for children and adults
3. Make sure your yearly wellness visit is covered 100%. Your provider must use these preventive medicine visit codes (pdf). In addition, some of our plans include two additional free visits with your primary care provider each year.

Want to know what services and providers your plan covers? Log into the member portal to view your Summary of Benefits and Coverage.

Yearly wellness exams and preventive services are not covered in the following circumstances:

• When you go to an out-of-network provider: You'll pay the full billed amount and the cost will go toward your out-of-network balances.
  • To receive health services at the lowest cost to you, always choose an in-network provider. Log into the member portal to search for providers in your network.
• When you ask your provider to solve an ongoing health problem: If you refer to a pain or sickness, the visit becomes diagnostic and might not be covered 100% as a "preventive yearly wellness visit."
  • This includes health-related questions such as, "Oh, by the way, could you help me with..." When the visit leads to more testing or medications, it may not be fully covered.

You are your best advocate. Your provider decides how to code visits, so don't be afraid to ask if discussing a certain issue will affect how you’ll be billed for the visit.