Preventive Health Services. If you only receive Preventive Health Services during a Physician office visit, there is no Copayment or Coinsurance for the visit. If you receive both Preventive Health Services and other Covered Services during the Physician office visit, you may have a Copayment or Coinsurance for the visit. Introduction Welcome! We are happy to have you as a Member of our Blue Shield of California (Blue Shield) health plan. At Blue Shield, our mission is to ensure all Californians have access to high-quality health care at an affordable price. To achieve this mission, we pledge to: • Provide personal service to you that is worthy of our family and friends; and • Build deep, trusting relationships with providers to improve the quality of health care and lower the cost. A Blue Shield health plan will help you pay for medical care and provide you with access to a network of doctors, Hospitals, and other Health Care Providers. The types of services that are covered, the providers you can see, and your share of cost when you receive care may vary depending on your plan.
Preventive Health Services. Benefits are available for Preventive Health Services such as screenings, checkups, and counseling to prevent health problems or detect them at an early stage. Benefits include: • Evidence-based items, drugs, or services that have a rating of A or B in the current recommendations of the United States Preventive Services Task Force (USPSTF), such as: o Screening for cancer, such as colorectal cancer, cervical cancer, breast cancer, and prostate cancer; o Screening for HPV; o Screening for osteoporosis; and o Health education; • Immunizations recommended by either the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, or the most current version of the Recommended Childhood Immunization Schedule/United States, jointly adopted by the American Academy of Pediatrics, the Advisory Committee on Immunization Practices, and the American Academy of Family Physicians; • Evidence-informed preventive care and screenings for infants, children, and adolescents as listed in the comprehensive guidelines supported by the Health Resources and Services Administration, including screening for risk of lead exposure and blood lead levels in children at risk for lead poisoning; • California Prenatal Screening Program; and • Additional preventive care and screenings for women not described above as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. See the Family planning Benefits section for more information. If there is a new recommendation or guideline in any of the resources described above, Blue Shield will have at least one year to implement coverage. The new recommendation will be covered as a Preventive Health Service in the plan year that begins after that year. Visit xxxxxxxxxxxx.xxx/xxxxxxxxxx for more information about
Preventive Health Services. Benefits are available for Preventive Health Services such as screenings, checkups, and counseling to prevent health problems or detect them at an early stage. Blue Shield only covers Preventive Health Services when you receive them from a Participating Provider. Benefits include: • Evidence-based items, drugs, or services that have a rating of A or B in the current recommendations of the United States Preventive Services Task Force (USPSTF), such as: o Screening for cancer, such as colorectal cancer, cervical cancer, breast cancer, and prostate cancer; o Screening for HPV; o Screening for osteoporosis; and o Health education; • Immunizations recommended by either the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, or the most current version of the Recommended Childhood Immunization Schedule/United States, jointly adopted by the American Academy of Pediatrics, the Advisory Committee on Immunization Practices, and the American Academy of Family Physicians; • Evidence-informed preventive care and screenings for infants, children, and adolescents as listed in the comprehensive guidelines supported by the Health Resources and Services Administration, including screening for risk of lead exposure and blood lead levels in children at risk for lead poisoning; • California Prenatal Screening Program; and • Additional preventive care and screenings for women not described above as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. See the Family planning Benefits section for more information. If there is a new recommendation or guideline in any of the resources described above, Blue Shield will have at least one year to implement coverage. The new recommendation will be covered as a Preventive Health Service in the plan year that begins after that year. Visit xxxxxxxxxxxx.xxx/xxxxxxxxxx for more information about
Preventive Health Services. If you only receive Preventive Health Services during a physician office visit, there is no Copayment or Coinsurance for the visit. If you receive both Preventive Health Services and other Covered Services during the physician office visit, you may have a Copayment or Coinsurance for the visit. Benefit Plans may be modified to ensure compliance with State and Federal requirements. The Blue Shield Trio HMO Health Plan Introduction to the Blue Shield Trio HMO Health Plan Trio HMO plans offer a limited selection of IPAs and medical groups from which Members must choose, and a limited network of Hospitals. The IPAs and medical groups in Trio HMO participate in account- able care organization collaborations with Blue Shield. It is important for Members to review the list of providers within the Trio HMO Physician and Hos- pital Directory before enrolling in this health plan. In many areas, there may only be one (1) IPA or Medi- cal Group from which to select a Primary Care Physician or to receive Covered Services. This Blue Shield of California (Blue Shield) Evi- dence of Coverage and Disclosure Form (EOC) de- scribes the health care coverage that is provided un- der the Group Health Service Contract between Blue Shield and the Contractholder (Employer). A Sum- xxxx of Benefits is provided with, and is incorpo- rated as part of, this EOC. Please read this EOC and Summary of Benefits care- fully. Together they explain which services are cov- ered and which are excluded. They also contain in- formation about the role of the Primary Care Physi- cian in the coordination and authorization of Cov- ered Services and Member responsibilities such as payment of Copayments, Coinsurance and De- ductibles. Capitalized terms in this EOC have a special mean- ing. Please see the Definitions section for a clear un- derstanding of these terms. Members may contact Shield Concierge with questions about their Bene- fits. Contact information can be found on the back page of this EOC. How to Use This Health Plan PLEASE READ THE FOLLOWING INFORMATION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED. Selecting a Primary Care Physician Each Member must select a general practitioner, family practitioner, internist, obstetrician/gynecol- ogist, or pediatrician as their Primary Care Physi- cian at the time of enrollment. Individual Family members must also designate a Primary Care Physician, but each may select a different provider as their Primary Care Phy...
Preventive Health Services. If you only receive Preventive Health Services during a Physician office visit, there is no Copayment or Coinsurance for the visit. If you receive both Preventive Health Services and other Covered Services during the Physician office visit, you may have a Copayment or Coinsurance for the visit.
Preventive Health Services. PacifiCare shall develop preventive health guidelines for the prevention and early detection of illness and disease (“Preventive Health Guidelines”) and shall encourage Members to use preventive health services. The Preventive Health Guidelines shall be maintained in accordance with the standards of Accreditation Organizations and shall be distributed to Participating Providers. Medical Group and its Participating Providers shall provide preventive health services required pursuant to the applicable Subscriber Agreements to Medical Group Members in accordance with the Preventive Health Guidelines.
Preventive Health Services a) Preventive health services means care and services to avert disease/illness and/or its consequences. There are three (3) levels of preventive health services: 1) primary, such as immunizations, aimed at preventing disease; 2) secondary, such as disease screening programs aimed at early detection of disease; and 3) tertiary, such as physical therapy, aimed at restoring function after the disease has occurred. Commonly, the term "preventive care" is used to designate prevention and early detection programs rather than restorative programs.
Preventive Health Services. If you only receive Preventive Health Services during a Physician office visit, there is no Copayment or Coinsurance for the visit. If you receive both Preventive Health Services and other Covered Services during the Physician office visit, you may have a Copayment or Coinsurance for the visit. Plans may be modified to ensure compliance with State and Federal requirements. Introduction Welcome! We are happy to have you as a Member of our Blue Shield of California (Blue Shield) health plan. At Blue Shield, our mission is to ensure all Californians have access to high-quality health care at an affordable price. To achieve this mission, we pledge to: • Provide personal service to you that is worthy of our family and friends; and • Build deep, trusting relationships with providers to improve the quality of health care and lower the cost. A Blue Shield health plan will help you pay for medical care and provide you with access to a network of doctors, Hospitals, and other Health Care Providers. The types of services that are covered, the providers you can see, and your share of cost when you receive care may vary depending on your plan.
Preventive Health Services. This includes mammograms, screenings for cervical cancer (pap smears), breast pumps, human papillomavirus (HPV) testing, counseling for sexually transmitted infections, counseling and screening for human immunodeficiency virus (HIV) and all FDA approved contraceptive methods as prescribed by a physician, sterilization procedures, education and counseling. (See the “Prescription Drug Services” section for coverage of contraceptive drugs.) For women whose family history is associated with an increased risk for BRCA1 or BRCA2 gene mutations, the Plan covers genetic counseling and BRCA screening without cost sharing, if appropriate and as determined by a physician. Network Benefits 100% of the charges incurred. Deductible does not apply. Non-Network Benefits 55% of the charges incurred, after you pay the deductible. Obesity Screening and Management. The Plan covers obesity screening and counseling. If you are age 18 or older and have a body mass index of 30 or more, the Plan covers intensive obesity management to help you lose weight. Your primary care physician can coordinate these services. Network Benefits 100% of the charges incurred. Deductible does not apply. Non-Network Benefits 55% of the charges incurred, after you pay the deductible. Preventive Medications. The Plan covers preventive medications currently recommended by the USPSTF with an A or B rating if they are prescribed by your medical provider and they are listed on the formulary. Preventive medications are subject to periodic review and modification. Changes would be effective in accordance with the federal rules and reflected in the Medical Coverage Criteria for preventive care services. Network Benefits 100% of the charges incurred. Deductible does not apply. Non-Network Benefits 55% of the charges incurred, after you pay the deductible. In addition to any ACA or state mandated preventive services referenced above, the Plan covers the following eligible services: Routine Eye Exams Network Benefits 100% of the charges incurred. Deductible does not apply. Non-Network Benefits 55% of the charges incurred, after you pay the deductible. Routine Hearing Exams Network Benefits 100% of the charges incurred. Deductible does not apply. Non-Network Benefits 55% of the charges incurred, after you pay the deductible. Prostate-Specific Antigen (PSA) Testing Network Benefits 100% of the charges incurred. Deductible does not apply. Non-Network Benefits 55% of the charges incurred, after you pay the deductib...
Preventive Health Services. If you only receive Preventive Health Services during a physician office visit, there is no Copayment or Coinsurance for the visit. If you receive both Preventive Health Services and other Covered Services during the physician office visit, you may have a Copayment or Coinsurance for the visit. Benefit Plans may be modified to ensure compliance with State and Federal requirements. The Blue Shield Access+ HMO Health Plan Introduction to the Blue Shield Access+ HMO Health Plan The Access+ HMO offers a wide choice of Physi- cians, Hospitals and Non-Physician Health Care Practitioners and includes special features such as Access+ Specialist and Access+ Satisfaction. This Blue Shield of California (Blue Shield) Evi- dence of Coverage and Disclosure Form (EOC) de- scribes the health care coverage that is provided un- der the Group Health Service Contract between Blue Shield and the Contractholder (Employer). A Sum- xxxx of Benefits is provided with, and is incorpo- rated as part of, this EOC. Please read this EOC and Summary of Benefits care- fully. Together they explain which services are cov- ered and which are excluded. They also contain in- formation about the role of the Primary Care Physi- cian in the coordination and authorization of Cov- ered Services and Member responsibilities such as payment of Copayments, Coinsurance and De- ductibles. Capitalized terms in this EOC have a special mean- ing. Please see the Definitions section for a clear un- derstanding of these terms. Members may contact Blue Shield Customer Service with questions about their Benefits. Contact information can be found on the back page of this EOC.
