Menu

Active School Participants - Preventive Care Benefits-at-a-Glance

School Actives

Adult Physical Exams

  • One per Calendar Year

In-Network: $20 copayment

Out-of-Network: Not covered

Well-Woman Office Visits

In-Network: $20 copayment

Out-of-Network: 20% after deductible plus any amount above the allowed amount

Well-Child Office Visits

  • From birth up to 1st birthday: 7 visits
  • Ages 1 through 4 years of age: 7 visits
  • Ages 5 through 11 years of age: 7 visits
  • Ages 12 up to 17 years of age: 6 visits
  • Ages 18 to 19th birthday: 2 visits

In-Network: $0

Out-of-Network: 20% after deductible plus any amount above the allowed amount

Adult Immunizations

In-Network: 20% coinsurance

Out-of-Network: 20% after deductible plus any amount above the allowed amount

Certain Child Immunizations

In-Network: $0

Out-of-Network: 20% after deductible plus any amount above the allowed amount

Cholesterol Testing

  • One every 24 months up to age 35; after age 35 one every 12 months

In-Network: $0

Out-of-Network: Not covered

Colonoscopy

The American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer suggest Colon Cancer screening should include any of the following:

  • Colonoscopy every 10 years
  • Double contrast barium enema every five years
  • CAT Scan colonography (virtual colonoscopy) every five years; requires precertification

In-Network: 20% coinsurance

Out-of-Network: 20% after deductible plus any amount above the allowed amount

Fecol Occult Blood Test (Colon Cancer)

  • Up to one test per year starting at age 40

In-Network: $0

Out-of-Network: 20% after deductible plus any amount above the allowed amount

PSA Blood Test

  • One test every 12 months for males with average risk starting at age 50; high risk start earlier

In-Network: $0

Out-of-Network: Not covered

Sigmoidoscopy-Diagnostic

  • Covered for participants age 40 and over: One test every 24 months

In-Network: $0

Out-of-Network: 20% after deductible plus any amount above the allowed amount

Sigmoidoscopy-Biopsy

In-Network: 20% coinsurance

Out-of-Network: 20% after deductible plus any amount above the allowed amount

Pap Smear Lab Test

  • Annual cervical cancer screening for females starting when sexually active

In-Network: $0

Out-of-Network: 20% after deductible plus any amount above the allowed amount

Preventive Mammogram

  • One baseline ages 35 – 39; annually starting at age 40, according to the recommendations of the American Cancer Society

In-Network: 20% coinsurance

Out-of-Network: 20% after deductible plus any amount above the allowed amount

Bone Density Testing and Treatment

  • Ages 52 through 64: one baseline
  • Ages 65 and older: one every 24 months (if baseline before age 65 does not indicate osteoporosis)

In-Network: 20% coinsurance

Out-of-Network: 20% after deductible plus any amount above the allowed amount

Newborn Exams

  • Two in-hospital exams at birth following vaginal delivery
  • Four in-hospital exams at birth following c-section delivery

In-Network: $0

Out-of-Network: 20% after deductible plus any amount above the allowed amount

For More Information

You can check the My Health section of www.anthembluecross.com for more information. There you’ll find the latest information on hundreds of topics ranging from nutrition to stress management to children’s immunization guidelines.

  • Local94 Image

Need to Find a Doctor, Dentist or Vision Specialist?

Find a Provider