False

ESSENTIAL HEALTH BENEFITS and Preventive Care


Our plans cover the Essential Health Benefits which are consistent with those set forth under the Patient Protection and Affordable Care Act of 2010. These Essential Health Benefits cover ten basic categories including:

  • Ambulatory patient services (outpatient)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral (provided by our partner carrier Delta Dental) and vision care

Preventive Care Services*, as defined by federal regulation, are paid at 100 percent when received in-network. Age and frequency schedules apply. Most preventive care falls into one of the following broad categories:

  • Office visits for preventive physical exams (e.g. adult physicals and well-child visits)
  • Screening tests (e.g. diabetes, cholesterol, high blood pressure, colonoscopy, PSA Prostate Specific Antigen, and STDs)
  • Adult and child immunizations (e.g. hepatitis, shingles, flu, pneumonia, and chicken pox)
  • Counseling and education interventions (e.g. diet and nutrition, disease prevention and alcohol or drug abuse)
  • Women's Services (e.g. contraception, prenatal services, breast cancer screenings, routine mammograms, and well woman routine OB/GYN visits and well child visits)

The list of covered preventive services is subject to change based on federal and state regulations.
To request a list of Preventive Services, contact Customer Care at 1-800-580-8502 or visit:
https://www.healthcare.gov/health-care-law-protections/free-preventive-care/

*The range of preventive care services covered at no cost share when provided in-network are designed to meet the requirements of federal and state law. The Department of Health and Human Services has defined the preventive services to be covered under federal law with no cost-share as those services described in the U.S. Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and Services Administration (HRSA) Guidelines. Members may have additional coverage under their health plan. Providers should verify eligibility and benefits for all members.


ESSENTIAL HEALTH BENEFITS and Preventive Care


Our plans cover the Essential Health Benefits which are consistent with those set forth under the Patient Protection and Affordable Care Act of 2010. These Essential Health Benefits cover ten basic categories including:

  • Ambulatory patient services (outpatient)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral (provided by our partner carrier Delta Dental) and vision care

Preventive Care Services*, as defined by federal regulation, are paid at 100 percent when received in-network. Age and frequency schedules apply. Most preventive care falls into one of the following broad categories:

  • Office visits for preventive physical exams (e.g. adult physicals and well-child visits)
  • Screening tests (e.g. diabetes, cholesterol, high blood pressure, colonoscopy, PSA Prostate Specific Antigen, and STDs)
  • Adult and child immunizations (e.g. hepatitis, shingles, flu, pneumonia, and chicken pox)
  • Counseling and education interventions (e.g. diet and nutrition, disease prevention and alcohol or drug abuse)
  • Women's Services (e.g. contraception, prenatal services, breast cancer screenings, routine mammograms, and well woman routine OB/GYN visits and well child visits)

The list of covered preventive services is subject to change based on federal and state regulations.
To request a list of Preventive Services, contact Customer Care at 1-800-580-8502 or visit:
https://www.healthcare.gov/health-care-law-protections/free-preventive-care/

*The range of preventive care services covered at no cost share when provided in-network are designed to meet the requirements of federal and state law. The Department of Health and Human Services has defined the preventive services to be covered under federal law with no cost-share as those services described in the U.S. Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and Services Administration (HRSA) Guidelines. Members may have additional coverage under their health plan. Providers should verify eligibility and benefits for all members.