Preventive Care Services. In addition to the benefits otherwise provided in this Certificate, (and notwith standing anything in your Certificate to the contrary), the following preventive care services will be considered Covered Services when ordered by your Primary Care Physician or Woman's Principal Health Care Provider and will not be sub ject to any deductible, Coinsurance, Copayment or benefit dollar maximum:
Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services, inclusive of current recommendations for breast cancer, that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note that recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography and prevention issued in or around November 2009 are not considered to be current. • Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. • Prostate cancer screening including digital rectal exams and prostate-specific antigen (PSA) blood tests for: ▪ Male Covered Persons who are between the ages of 40 and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancer. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a voluntary basis; and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessment. Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxx...
Preventive Care Services. Physician office services None Yes No Lab, X-ray or other preventive tests None Yes No Breast pumps None Yes No
Preventive Care Services. Preventive Care Services include, Outpatient services and Office Services. Screenings and other Health Services are Covered as Preventive Care for adults and children with no current symptoms or prior history of a medical condition associated with that screening or service. Enrollees who have current symptoms or have been diagnosed with a medical condition are not considered to require Preventive Care for that condition but instead benefits will be considered under the Diagnostic Health Services benefit. Preventive Care Services in this section shall meet requirements as determined by federal and state law. Health Services with an “A” or “B” rating from the United States Preventive Services Task Force (USPSTF) and subject to guidelines by the USPSTF.
Preventive Care Services. See Prevention and Early Detection Services for coverage of annual preventive office visits.) Allergy injections - Applies to injection only, including administration. 0% - After deductible 40% - After deductible Hospital based clinic visits 0% - After deductible 40% - After deductible Pediatric clinic visits 0% - After deductible 40% - After deductible PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls and pediatric clinic visits. 0% - After deductible 40% - After deductible Retail clinics 0% - After deductible 40% - After deductible Specialists Office visits and house calls rendered by a specialist (other than a behavioral health specialist). Specialist includes but is not limited to allergists, dermatologists and podiatrists. 0% - After deductible 40% - After deductible Office visits and house calls rendered by a behavioral health specialist. 0% - After deductible 40% - After deductible Organ Transplants Organ transplant services 0% - After deductible 40% - After deductible Physical/Occupational Therapy Outpatient hospital/in a physician’s/therapist’s office. 0% - After deductible 40% - After deductible
Preventive Care Services. The coverage described below shall be consistent with the requirements of the Affordable Care Act (ACA). Preventive Care Services are covered for children and adults, as directed by your Physician, based on the guidelines from the following resources: • U.S. Preventive Services Task Force Grade A & B recommendations (xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx/xxxxxx/xxxxxxxxxx.xxx) • The Advisory Committee on Immunization Practices (ACIP) that have been adopted by the Center for Disease Control and Prevention (xxx.xxx.xxx/xxxxxxxx/xxxx/XXXX/) • Guidelines for infants, children, adolescents and women’s preventive health care as supported by the Health Resources and Services Administration (HRSA) (xxx.xxxx.xxx/xxxxxxxxxxxxxxxx/) Your Physician will evaluate your health status (including, but not limited to, your risk factors, family history, gender and/or age) to determine the appropriate Preventive Care Services and frequency. The list of Preventive Care Services are available through xxx.xxxxxxxxxx.xxx/xxxx/xxxxxxxxxx/0000/00/xxxxxxxxxx- services-list.html. Examples of Preventive Care Services include, but are not limited to: • Periodic health evaluations • Preventive vision and hearing screening • Blood pressure, diabetes, and cholesterol tests • USPSTF and HRSA recommended cancer screenings, including FDA-approved human papillomavirus (HPV) screening test, screening and diagnosis of prostate cancer (including prostate-specific antigen testing and digital rectal examinations), screening for breast, cervical and colorectal cancer, human im- munodeficiency virus (HIV) screening, mammograms and colonoscopies • Developmental screenings to diagnose and assess potential developmental delays • Counseling on such topics as quitting smoking, lactation, losing weight, eating healthfully, treating depression, prevention of sexually transmitted diseases, and reducing alcohol use • Routine immunizations against diseases such as measles, polio, or meningitis • Flu and pneumonia shots • Vaccination for acquired immune deficiency disorder (AIDS) that is approved for marketing by the FDA and that is recommended by the United States Public Health Service • Counseling, screening, and immunizations to ensure healthy pregnancies • Regular well-baby and well-child visits • Well-woman visits Preventive Care Services for women also include screening for gestational diabetes; sexually-transmitted infection counseling; human immunodeficiency virus (HIV) screening and counseling; FDA-ap...
Preventive Care Services. See Prevention and Early Detection Services for coverage of annual preventive office visits.) Allergy injections - applies to injection only, including administration. 0% Not Covered Diabetic office visits Podiatrist services - first routine visit in a plan year $0 Not Covered Vision care services - first routine eye exam in a plan year that includes a retinal eye exam. $0 Not Covered Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. Network Providers Non-network Providers (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay Hospital based clinic visits $30 Not Covered PCP visits - including behavioral health. Visits include PCP office visits and PCP house calls and pediatric clinic visits. $20 Not Covered Retail clinics $20 Not Covered Specialists - office visits and house calls rendered by a specialist. Specialist includes but is not limited to behavioral health, allergists, dermatologists and podiatrists. $30 Not Covered Organ Transplants Organ transplant services 20% - After deductible Not Covered Physical/Occupational Therapy Outpatient hospital/in a physician’s/therapist’s office. 20% - After deductible Not Covered
Preventive Care Services. A) Periodic physical examinations as medically indicated by the age, sex, and medical history of the Member.
Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: Evidence-based items or services, inclusive of current recommendations for breast cancer, that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note that recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography and prevention issued in or around November 2009 are not considered to be current. Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. A recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention is considered to be: In effect after it has been adopted by the director of the Centers for Disease Control and Prevention; and For routine use if it is listed on the immunization schedules of the Centers for Disease Control and Prevention. With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. With respect to women, such additional preventive care and screenings, not described above, as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. Preventive care Benefits defined under the Health Resources and Services Administration requirement include the cost of renting one breast pump at a time per Pregnancy in conjunction with childbirth. If more than one breast pump can meet your needs, Benefits are available only for the most cost effective pump. We will determine the following: Which pump is the most cost effective. Whether the pump should be purchased or rented. Duration of a rental. Timing of an acquisition.
Preventive Care Services. Preventive care services and routine well-baby and well-child care (pediatric exams) will be covered on an out-of- network basis at 100% of the MAA, not subject to the deductible. (Amend the following sections of the FMEP: Sections 5.2.3 and 8.16.)
