Preventive Benefits
The State Health Plan is committed to providing preventive services 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 Eye Exam
Benefits are only available in-network
Coverage is provided for one routine eye exam per benefit period for your primary care copayment. In addition, you will receive a 30% discount on eyewear and hard contact lenses from participating providers with dispensaries. A 15% discount is available for soft contact lenses.
Routine Hearing Exam
Benefits are only available in-network
Coverage is provided for one routine hearing exam per benefit period. The co-payment amount is dependent on whether you receive care from an in-network primary care provider or an in-network specialist.
The following preventive care benefits are available both in- and out-of-network:
For Wellness Services, see the Wellness page.
For Disease and Case Management Services, see the Disease Management page.
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 Eye Exam
Benefits are only available in-network
Coverage is provided for one routine eye exam per benefit period for your primary care copayment. In addition, you will receive a 30% discount on eyewear and hard contact lenses from participating providers with dispensaries. A 15% discount is available for soft contact lenses.
Routine Hearing Exam
Benefits are only available in-network
Coverage is provided for one routine hearing exam per benefit period. The co-payment amount is dependent on whether you receive care from an in-network primary care provider or an in-network specialist.
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
For Wellness Services, see the Wellness page.
For Disease and Case Management Services, see the Disease Management page.
