Preventive Care Coverage

It is important to make smart decisions about preventive services in order to get the most out of your health care.

Preventive care services include routine exams, check-ups, immunizations, and counseling, based on age and potential risk factors. Your physician will counsel you on how often you should receive preventive care services, and what type. The following lists of preventive health care services are not comprehensive, and you should visit the appropriate website for the comprehensive list. 

Determining your coverage 

• Most health plans (including individual policies, and fully insured, employer-based plans, and non-grandfathered self-funded plans) are required to provide 100 percent coverage for eligible preventive services defined by federal guidelines.
• If you are unsure what type of health plan you are covered under, ask your employer or insurance broker. 
• These services are to be covered in full, regardless of whether your plan has a deductible. Services must be received from a participating plan provider. 

Appealing a claim 

• If your health plan denies a claim, you can appeal it. First, contact your health plan and ask for more information on why the claim was denied. You can ask your health plan to review its decision and reconsider. 
• Most health plans must provide a process that allows you to request an independent, external review of the denial of a claim, if your appeal is denied.