Commercial Participants - Preventive Care Benefits-at-a-Glance
Commercial Actives and PPO Retirees
Adult Physical Exams
- One per Calendar Year
In-Network: $20 copayment
Out-of-Network: Not covered
Well-Woman Office Visits
In-Network: $20 copayment
Out-of-Network: 20% after deductible plus any amount above the allowed amount
Well-Child Office Visits
- From birth up to 1st birthday: 7 visits
- Ages 1 through 4 years of age: 7 visits
- Ages 5 through 11 years of age: 7 visits
- Ages 12 up to 17 years of age: 6 visits
- Ages 18 to 19th birthday: 2 visits
In-Network: $0
Out-of-Network: 20% after deductible plus any amount above the allowed amount
Adult Immunizations
In-Network: 20% after deductible
Out-of-Network: 20% after deductible plus any amount above the allowed amount
Certain Child Immunizations
In-Network: 20% after deductible
Out-of-Network: 20% after deductible plus any amount above the allowed amount
Cholesterol Testing
- One every 24 months up to age 35; after age 35 one every 12 months
In-Network: $15 copayment
Out-of-Network: Not covered
Colonoscopy
The American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer suggest Colon Cancer screening should include any of the following:
- Colonoscopy every 10 years
- Double contrast barium enema every five years
- CAT Scan colonography (virtual colonoscopy) every five years; requires precertification
In-Network: 20% after deductible
Out-of-Network: 20% after deductible plus any amount above the allowed amount
Fecal Occult Blood Test (Colon Cancer)
- Up to one test per year starting at age 40
In-Network: $15 copayment
Out-of-Network: 20% after deductible plus any amount above the allowed amount
PSA Blood Test
- One test every 12 months for males with average risk starting at age 50; high risk start earlier
In-Network: $15 copayment
Out-of-Network: Not covered
Sigmoidoscopy—Diagnostic
- Covered for participants age 40 and over: One test every 24 months
In-Network: $15 copayment
Out-of-Network: 20% after deductible plus any amount above the allowed amount
Sigmoidoscopy—Biopsy
In-Network: 20% after deductible
Out-of-Network: 20% after deductible plus any amount above the allowed amount
Pap Smear Lab Test
- Annual cervical cancer screening for females starting when sexually active
In-Network: $15 copayment
Out-of-Network: 20% after deductible plus any amount above the allowed amount
Preventive Mammogram
- One baseline ages 35 – 39; annually starting at age 40, according to the recommendations of the American Cancer Society
In-Network: 20% after deductible
Out-of-Network: 20% after deductible plus any amount above the allowed amount
Bone Density Testing and Treatment
- Ages 52 through 64: one baseline
- Ages 65 and older: one every 24 months (if baseline before age 65 does not indicate osteoporosis)
In-Network: 20% after deductible
Out-of-Network: 20% after deductible plus any amount above the allowed amount
Newborn Exams
Newborn Exams
- Two in-hospital exams at birth following vaginal delivery
- Four in-hospital exams at birth following c-section delivery
In-Network: $0
Out-of-Network: 20% after deductible plus any amount above the allowed amount
For More Information
For more information on preventive care, please visit the SPD for Actives and Retirees in the Commercial Division section.
You can also check the My Health section of www.anthembluecross.com. There you’ll find the latest information on hundreds of topics ranging from nutrition to stress management to children’s immunization guidelines.
FAQs
What if I get injured on the job?
Benefits are not payable for occupational accidents, injuries or sickness covered by any Workers’ Compensation statute or similar legislation. All claims in relation to an injury or a condition that is directly or indirectly job-related are not covered by the Fund. For more information, please visit the Health and Safety section.