Keeping Your Health On Track

Discussing the preventive care needs of you and your family with your physicians and other health care providers is the first step to maintaining your health and keeping your health on track. Your Service Benefit Plan makes it easy to get the appropriate preventive care. Most types of care are covered in full, or with a low copayment, under both Standard and Basic Options.

Why Is Preventive Care So Important?

An important part of keeping you healthy at any age is routine physical examinations and preventive screening tests. Routine examinations and screening tests help to identify medical conditions you may not be aware of or for which you have not experienced any symptoms. Early detection of most conditions means you can start any necessary treatment at an earlier stage. Getting treatment during the early stages of an illness can help improve your chances for recovery and/or improve your ability to control the condition.

Preventive Care For Adults

Both Standard and Basic Options provide benefits for routine physical examinations when you use a Preferred provider. Under Standard Option, you pay only $15 for the examination. You pay $20 for a routine examination by a primary care physician under Basic Option. Standard and Basic Option benefits are not available for routine examinations performed by Non-preferred providers.

When you use a Preferred provider, you pay nothing for routine screening procedures. Under Standard Option, this includes:

• A history and risk assessment

• A chest X-ray

• EKG

• Urinalysis

• General Health Panel

• Basic or comprehensive metabolic panel test

• Complete Blood Count (CBC)

• Fasting lipoprotein profile (total cholesterol, LDL, HDL, and/or triglycerides)

Basic Option benefits are provided for all of the services listed above and for other appropriate screening tests and services.

Standard and Basic Option benefits are also provided in full, when you use a Preferred Provider, for the following cancer diagnostic and screening procedures:

• Colorectal cancer tests such as fecal occult blood tests, colonoscopies, sigmoidoscopies, and double contrast barium enema

• Prostate cancer tests such as the Prostate Specific Antigen (PSA) test

• Cervical cancer tests such as a Pap test

• Mammograms

In addition, benefits are available under both options for a diagnostic or screening ultrasound for an aortic abdominal aneurysm.

Routine immunizations are covered in full for adults under your Service Benefit Plan coverage when you use a Preferred Provider. Covered immunizations for adults are:

• Hepatitis Types A and B for patients with increased risk or a family history of these conditions

• Herpes Zoster or shingles vaccine

• Human Papillomavirus (HPV) vaccine

• Flu vaccine once every flu season

• Pneumococcal vaccine

• Meningococcal vaccine

• Tetanus-diphtheria (Td) booster once every ten years.

Preventive Care For Children

Under the Service Benefit Plan, children are defined as dependents under your coverage up to the age of 22.

Benefits for preventive care for children include newborn care and any routine newborn screening tests. Benefits are also available for the following routine services and any related office visits as recommended by the American Academy of Pediatrics:

• Routine physical examinations

• Routine hearing tests

• Laboratory tests

• Immunizations

• Human Papillomavirus (HPV) vaccines

• Meningococcal vaccine

• Rotavirus vaccine

If you have Standard Option coverage for your family and use a Preferred Provider, you pay nothing for covered preventive care services for children. If you use a Non-preferred provider, you are responsible for any difference between our payment and the provider’s charge. Under Basic Option, you must use a Preferred provider for the care to be eligible for benefits. So if you have Basic Option and use a Preferred provider, you pay nothing. You are responsible for all changes under Basic Option if you use a Non-preferred provider.

Preventive care is a part of the health care needs of you and your family. Your Service Benefit Plan covers routine examinations and most screening procedures for you and your children. For more information about benefits for preventive care, please refer to Section 5(a) of the 2008 Service Benefit Plan brochure.

Written by Paula Spurway, Blue Cross and Blue Shield Association. Originally published in January 2008. Resource: 2008 Blue Cross and Blue Shield Service Benefit Plan brochure.