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State Members

Preventive Services

HSA Plan

Network

100% coverage

Non-Network

40% coinsurance after deductible*

PPO 600 Plan

Network

100% coverage

Non-Network

30% coinsurance after deductible**

PPO 300 Plan

Network

100% coverage

Non-Network

30% coinsurance after deductible**

For benefits to be covered as preventive, including exams and other services ordered as part of the exam, they must be coded by the provider as routine — without indication of injury or illness.

Medical Screenings

Preventive care and screenings recommended by the U.S. Preventive Services Task Force (categories A and B), for women supported by the Health Resources and Services Administration (HRSA), and for infants, children and adolescents supported by the HRSA are covered at 100% when received from a network provider.

The preventive care benefit includes, but is not limited to:

 

  • Cancer screenings
  • Alcohol Misuse: Screening and Brief Behavioral Counseling
  • Annual Medical Exam
  • Depression in Adults, Screening
  • Diabetes Mellitus, Screening
  • Hepatitis C Virus Infection in Adults, Screening
  • Obesity in Adults, Screening
  • Preventive exams and other services ordered as part of the exam
  • Tobacco Use in Adults, Counseling and Interventions

Men

  • Abdominal Aortic Aneurysm, Screening

Women

  • Breastfeeding, Counseling and Breast Pump
  • Osteoporosis, Screening

Children

  • Well Child Exam — including depression, obesity, hearing and vision screenings and immunizations

100% Prescription Coverage

There are certain medications that MCHCP will cover at 100% when accompanied by a prescription and filled or administered at a network pharmacy. Covered drugs are those described in the U.S. Preventive Services Task Force (categories A and B), the Advisory Committee for Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA) Guidelines for women, as well as children, including the American Academy of Pediatrics Bright Futures periodicity guidelines.

The preventive care benefit includes, but is not limited to:

  • Preferred1 birth control (non-preferred may be covered in limited situations)
  • Generic Vitamin D, 1,000 IU or less. Vitamin D2 and D3 products as well as combination products that contain calcium are covered
  • Over-the-counter (OTC) nicotine replacement therapy
  • Preferred1 brand and generic quit tobacco medications for members aged 18 and over
  • Generic Tamoxifen, generic Raloxifene, and brand Soltamox (Tamoxifen liquid for patients who have difficulty swallowing Tamoxifen tablets) for the prevention of breast cancer
  • Non-Medicare Prescription Drug Plan: Generic Aspirin, up to 325mg for men and women up to age 60
  • Medicare Prescription Drug Plan: Generic Aspirin, up to 325mg – no age or gender restrictions
  • Generic Folic Acid, 400 to 800 mcg/day for women up to age 50
  • Generic bowel prep (preferred1 and OTC)
  • Influenza (Flu) Vaccination
  • Shingles (Zoster) Vaccination
  • Flouride for children aged 6 months through 12 years
  • Iron supplement for members aged 6-12 months

1Preferred drug as determined by ESI

 

 *Immunizations: 100% coverage from birth to 72 months, 40% coinsurance after deductible for persons age 6 and older
**Immunizations: 100% coverage from birth to 72 months, 30% coinsurance after deductible for persons age 6 and older

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