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Preventive Care

The State Health Plan is committed to providing preventive services to covered members at the lowest cost possible to help members lead healthy, happy and productive lives. Preventive care benefits include routine physical and screening procedures, laboratory tests and immunizations.

Routine Physical and Screening Procedures

Routine physicals are only available in-network. The PPO plans provide coverage for one routine physical examination and related diagnostic per benefit period for each member age two and over. Your office visit copay will cover all preventive services when provided by an in-network provider in his or her office.

Well-Baby and Well-Child Care

Benefits are only available in-network. The PPO Plans provide coverage for each member up to 24 months of age including periodic assessments and immunizations. Benefits are limited to six well-baby visits for members through 12 months old and three well-child visits for members 13 months up to 24 months old. Your office visit copay will cover all well-baby and well-child care when provided by an in-network provider in his or her office.

Immunizations

Benefits are only available in-network. Coverage is provided in-network for the full series of standard immunizations recommended by the federal Centers for Disease Control and Prevention (CDC).

Routine Mammograms

Beginning at age 35, coverage is provided for one screening mammogram per female member per benefit year. Along with a doctor’s interpretation of the results. Screening mammograms are covered at 100% when provided alone.

Routine Hearing Exam

Benefits are only available in-network Coverage is provided for one routine hearing exam per benefit period. The copayment amount is dependent on whether you receive care from an in-network primary care provider or an in-network specialist.

Other Preventive Care Benefits

The following preventive care benefits are available both in- and out-of-network:

  • Gynecological exams
  • Cervical cancer screening
  • Ovarian cancer screening
  • Screening mammograms
  • Colorectal screening
  • Prostate specific antigen tests