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All three PPO plans include wellness benefits that pay 100% of in-network eligible charges for routine preventive care services for each covered person. Wellness benefits examples include: Routine physical exams (no limit on visits) Routine diagnostic tests (lab and x-ray) Routine eye exams Routine hearing exams Women’s Health Preventative Care (including birth control and breast pumps) will be reimbursed at 100% of contracted rates while using an in-network provider Immunizations (immunizations for foreign travel are not covered)
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Examples of Routine Wellness Care |
Routine Physical Exam Blood Pressure Screening Annual Mammogram Clinical Breast Exam | Annual Pap Smear Well-Baby/Child Care Annual Prostate Exam | Annual Fasting Blood Sugar Test Annual Cholesterol Test Routine Lab (blood, urine) Testing |
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Affordable Care Act (ACA) Preventive
Under the ACA there are certain drugs that are considered preventative. Examples of these medications include doctor-written prescriptions for women’s health preventive care, including Food and Drug Administration-approved contraceptive methods, preventive aspirin for men and women, iron supplements for children, folic acid for childbearing age or pregnant women, Vitamin D for at-risk adults over age 65, prescribed fluoride supplements for children under age six and tobacco cessation products. All preventive drugs and treatments require a doctor’s prescription under the preventive tier.
Added Wellness Services:
Chlamydia infection screening Gonorrhea and syphilis screening Testing for HPV - the virus that can cause cervical cancer Counseling about genetic testing for breast cancer Counseling to help stop use of tobacco products Screening for diabetes for persons with high blood pressure Osteoporosis (bone density) screening Cholesterol screening based on age and individual risk factors
| Colorectal cancer screenings Screening and counseling for alcohol misuse Use of folic acid to promote health Use of aspirin to prevent heart disease Health counseling to include nutrition and weight management Interpersonal and domestic violence screening and counseling Female sterilization including tubal ligation*
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*Certain restrictions may apply; there might be copay, coinsurance or deductible in some cases - refere to your plan materials or contact BCBS IL for more information. Hysterectomies are not considered part of the women's preventive care benefit.
Immunizations:
Contraceptives: (Administered by CVS Caremark)
Prescription - One or more products within the categories approved by the FDA for use as a method of contraception
Over-the-counter - Contraceptives available over-the-counter approved by the FDA for women (foam, sponge, female condoms) when prescribed by a physician
The morning after pill
Medical devices such as IUD, diaphragm, cervical cap and contraceptive implants
Women’s Health Preventative Care
Women’s Health Preventative Care (including birth control and breast pumps) will be reimbursed at 100% of contracted rates while using an in-network provider.
Additional preventative service for pregnancies include:
Anemia screening for iron deficiency
Syphilis screening
Hepatitis B screening
Blood testing for Rh incompatibility
Screening for diabetes which develops during pregnancy
Urinary tract infection screening
Breastfeeding education
Breastfeeding support and counseling by a trained in-network provider during pregnancy and/or after giving birth
Breastfeeding specialist/nurse practitioner with state-recognized certification who is in the provider network
Breast pumps (manual, electric and hospital grade; some limitations or restrictions may apply)
For Prescriptions and Over the Counter Drugs
Covered at 100% (not subject to copays or deductibles)
Age, gender and quantity limits may be applied
Over the counter drugs require a prescription to be dispensed and covered through the medical plan*
Types of medication include: Aspirin (men and women) Iron Supplements (children) Oral Fluorides (children) Folic Acid (women only) Tobacco Cessation (adults) Vitamin D (men and women)
| Contraceptives (female only): Oral Contraceptives Emergency Contraceptives Injectable Contraceptives IUDs, Subdermal rods, & vaginal rings Transdermal Patch Barrier methods - diaphragm, cervical cap OTC - female condoms, vaginal sponge, spermicides
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The above are examples of preventive care drugs under the Affordable Care Act. Certain drugs are subject to restrictions. Check with your provider or Caremark for more information.
Wellness Care Tips
Here are some key things to remember about your wellness benefits through Farm Credit Foundations.
- When you schedule an appointment, be sure to specify it is for a wellness appointment.
- You do not have a copayment for routine/preventive exams and lab work.
- Your preventive exams are not subject to frequency schedules.
- For more information regarding your wellness benefits contact BlueCross BlueShield of Illinois at 1-866-563-8366.
