Preventive Care Benefits
One of the best ways to prevent illness is to take care of yourself. Regular check-ups and immunizations are important, so preventive care services provided in an outpatient setting are covered.
Eligible preventive care services are covered at 100% without deductibles or copayments. Routine tests and related lab and X-ray expenses are covered once per calendar year.
The Plan pays benefits for preventive care services provided on an outpatient basis at a physician's office, an alternate facility or a hospital. Preventive care services 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 that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force;
  • 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; and
  • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration.
In general, the Plan pays preventive care benefits based on the recommendations of the U.S. Preventive Services Task Force (USPSTF) although other preventive care services may be covered as well. Your physician may recommend additional services based on your family or medical history. Examples of preventive medical care are listed below and provide a guide of what is considered a covered health service.
  • Routine physical exam (one per year after age 3)
  • Well child care through age 3
  • Routine lipid profile
  • Routine mammogram (including three-dimensional (3-D) breast cancer mammography)
  • Routine PAP test
  • Additional women's preventive care (per PPACA guidelines):
    • Gestational diabetes screening
    • HPV DNA testing for women age 30 and older
    • Screening for sexually transmitted infections
    • Screening and counseling for HIV
    • Screening and counseling for domestic violence
    • Counseling for and payment of generic FDA-approved contraception methods
    • Counseling for breastfeeding and payment of rental equipment and supplies
    • Pre-eclampsia screening (included in prenatal visit)
  • Routine lab tests and X-rays related to covered preventive testing (facility and professional charges)
  • Breast pumps:
Preventive care benefits defined under the Health Resources and Services Administration (HRSA) requirement include the cost of renting one breast pump per pregnancy in conjunction with childbirth. Benefits for breast pumps also include the cost of purchasing one breast pump 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. UnitedHealthcare 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.
Benefits are only available if breast pumps are obtained from a DME provider or physician.
  • Immunizations:
    • Covered childhood immunizations generally include: Diptheria-tetanuspertussis (DTP), Oral poliovirus (OPV), Measles - mumps- rubella (MMR), Conjugate haemophilus influenza type B, Hepatitis B, Rotavirus vaccine, Varicella (Chicken Pox) and human papilloma virus (HPV) vaccine for ages 9-18.
    • The HPV vaccine is limited to one complete dosage per lifetime. Women over age 18 but under age 26 who have not yet received the vaccine may receive the vaccine.
  • Statins for prevention of cardiovascular disease for adults ages 40 - 75
  • Adult latent tuberculosis screening
  • Colorectal cancer fecal DNA test for adults ages 50 to 75
Preventive care benefits do not include:
  • Services for the diagnosis or treatment of a disease, except for those women's preventive services noted above
  • Medicines, drugs, appliances, equipment or supplies, except for those women's preventive services noted above
  • Psychiatric, psychological or emotional testing or exams
  • Exams related to employment
  • Premarital exams
  • Vision or dental exams
To confirm whether a service is covered as a preventive care benefit, contact UnitedHealthcare at 800 387 7508.