The Affordable Care Act (ACA) requires nongrandfathered health insurance plans to cover outlined preventive services at not charge. The services must be performed by an in-network provider, doctor, and/or facility in order to be covered at 100%. Helpful Hint: Make sure to get the preventive services from an in-network provider. Out of network providers are not covered. You can visit our doctor finder if you need assistance finding a provider.

What are preventive services?

Preventive services include screenings, counseling, routine immunizations, childhood preventive services, and preventive services for women. Make sure to make the most out of your no-cost preventive care coverage to improve your overall health! You can view a list of recommended covered preventive services here. For a complete list of preventive services call the customer care number on the back of your health insurance ID card.

Is it Preventive or Diagnostic?

When you receive treatment solely for the purpose of a screening exam, with no symptoms of a disease, then such a treatment is typically considered preventive. Whereas a treatment or screening to rule out or confirm a suspected diagnosis (or you having symptoms) is considered a diagnostic exam and not covered under preventive. Helpful Hint: Make sure that your doctor knows that you are coming in for your preventive exam. The doctor needs to use the appropriate code with the insurance carrier.

Note: If you have a grandfathered plan, you might not receive these benefits. If there is any difference between the information on this blog and your health plan, your policy’s provisions will apply.