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
FAQs
How do I name a beneficiary?
If you are married, your spouse is automatically your beneficiary. With your spouse’s consent, you may change your beneficiary. You can and should name a secondary and tertiary (third) beneficiary in the event your primary beneficiary predeceases you. Complete a form if naming anyone other than your legal spouse. Your spouse must also sign the form and it must be notarized.
If you are single, you should name a beneficiary by completing a form and submitting it to John Hancock Retirement Plan Services. If you are single and do not name a beneficiary(ies), your estate will receive your account in the event of your death.