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
As an Active Member, what is our hospital and medical coverage?
The Health and Benefit Trust Fund offers hospital and medical benefits to active eligible participants. Medical benefits include coverage for preventive care, doctor visits, hospital stays and other medical services. The Health and Benefit Trust Fund shares most of the cost of medical services when you visit in-network providers, meaning you pay less out-of-pocket for your health care. For more information, go to the Medical Benefits page.