Preventive care - PEBB

Preventive care

It might be hard to remember to go to the doctor when you’re not sick, but getting an annual checkup and other preventive care exams is one of the easiest ways to protect your health. That's why UMP plans cover a wide variety of preventive services with no copay, no coinsurance, and no deductible, meaning no out-of-pocket costs to you when you see a provider in your plan's network.

What's covered?

Here are a few examples of covered preventive care:

  • Annual physical exam
  • Blood pressure screening
  • Screening mammograms for members ages 40 and older
  • Cervical cancer screening (pap smear)
  • Covered immunizations. To find out which immunizations are considered preventive, check the Centers for Disease Control (CDC) immunizations schedules.

See the full preventive care list on HealthCare.gov or call UMP Customer Service to ask if a service is covered as preventive. Note that recommendations added during the calendar year may not be covered as preventive until later years. For preventive prescription drugs, refer to the Preferred Drug List (PDL) or call Washington State Rx Services.

Avoid charges

You pay $0 for covered preventive services when you see a provider in your plan's network. If you see an out-of-network provider, you will pay the out-of-network rate, plus any amount charged by the provider above the plan’s allowed amount.
Follow-up visits or tests are not covered under the preventive care benefit.

You pay $0 for covered preventive immunizations when received from a provider in your plan's network, network pharmacy, or public health department. The plan does not cover immunizations for travel or employment, even when recommended by the CDC or required by travel regulations.
You pay $0 for covered preventive drugs when you fill your prescription at a network pharmacy. If you fill at an out-of-network pharmacy, you will need to submit a claim and you will pay the difference between the allowed amount and what the pharmacy charges.

WSRxS does not provide BlueCross BlueShield services and is a separate company solely responsible for its product/services.