Preventive Care Tip Sheet
Your powerful preventive care benefits
With your Premera health plan, you can access excellent preventive care benefits.
When you use an in-network provider, ALL preventive care is covered at 100%. Getting
timely preventive care is one way to detect potential health issues before they become
serious and possibly expensive to treat. So don’t waste time—schedule your annual
check-up and vaccinations right away!
Making the most of your coverage
•• When you make your appointment, be sure to tell the scheduler that you want a
preventive exam.
•• Bring this Preventive Care Services flyer with you to show your doctor what’s considered
preventive and covered in full under your medical plan.
•• If you receive a prescription, be sure to ask whether there is a generic option.
You’re likely to save money with a generic choice.
•• Recommendations may vary—so discuss the start and/or frequency of preventive
screenings with your doctor, especially if you have health risks.
Note: Your doctor may recommend or provide additional services or diagnostics during
your preventive exam. These services may not be covered at 100%, and you may be
responsible for a portion of the cost. If you are concerned about costs, ask your doctor
to call Premera for an estimate before proceeding.
Need to find a doctor?
No problem. For a list of providers, go to mysbuxben.com. Under the “Health Plans”
tab, click “Premera Online.” Then click “Find a Doctor” for providers by name, specialty,
hospital affiliation, and languages spoken. Be sure to choose one of these in-network
providers. Preventive care is only covered when you choose an in-network provider.
After your visit, you’ll get a Premera Explanation of Benefits (EOB) in the mail. If your visit
was limited to the preventive care detailed on this flyer and received from an in-network
provider, your cost will be $0.
Premera customer service help
If you have questions while at your appointment—or at any time—you can contact
Premera Partner Services at 877-728-9020.
Remember: the power is in your hands. Take advantage of your preventive care benefits
for better health—and healthcare savings.
Preventive Care Services
Using your preventive benefits is a good way to maintain and even improve your health.
You must utilize an in-network provider to receive benefits for preventive care.
It’s also a good idea to bring a copy of this list to your exam so your doctor is aware
of your coverage.
When the services listed are given by an in-network provider and billed as routine
Preventive Services, your plan covers them in full.
Adults
Preventive services
•• Wellness exams 18+
•• Abdominal aortic aneurysm
(one-time screening for men of specified
ages who have ever smoked)
•• Alcohol misuse screening and counseling
•• Blood pressure screening
•• Breast cancer (screening mammography)
•• Cholesterol (for adults of certain ages
or those at higher risk)
•• Colorectal cancer screening (colonoscopy,
sigmoidoscopy, and fecal occult blood)
•• Depression screening
•• Diabetes screening (type 2)
•• Domestic violence screening
and counseling
Immunizations
•• Hepatitis A
•• Human papillomavirus (HPV)
•• Meningococcal (meningitis)
•• Hepatitis B
•• Influenza (Flu)
•• Tetanus, diphtheria, pertussis (TdaP)
•• Herpes zoster (shingles)
•• Measles, mumps, rubella, (MMR)
•• Varicella (chicken pox)
•• Pneumococcal (pneumonia)
•• Healthy eating assessment and
dietary counseling
•• HIV Infection screening all adults
at higher risk
•• Obesity screening and counseling
for weight loss
•• Prostate cancer screening (PSA blood test)
•• Sexually transmitted infection (STI)
screening and counseling for those
at higher risk
•• Sterilization
•• Syphilis testing for those at higher risk
•• Tobacco use screening and interventions
•• Fall prevention for ages 65 and over
Medications
and supplements
•• Aspirin—over the counter, aspirin only
products, for those at risk due to heart
conditions, between the ages of 45 and 79
(75–325 mg)
•• Folic acid—over the counter, women
only who are pregnant or are considering
pregnancy; strength 0.4–0.8 mg
•• Tobacco cessation—prescription only
for Bupropion, Chantix, NRT (nicotine
replacement therapy) nasal spray, or
NRT inhaler
•• Birth control pills—generics and
brand name
•• Vitamin D—ages 65 and over with written
prescription, 500 mg or 1,000 mg
Recommended age and frequency varies. Talk with your provider about tests, screenings,
and immunizations that are right for you. Women
Additional covered preventive services
•• Bone density (osteoporosis screening)
•• Breast cancer (chemoprevention counseling
for women at higher risk)
•• Breast cancer (screening mammography)
•• Cervical cancer (PAP smear)
•• Chlamydia infection screening
•• Gonorrhea screening (for women at higher risk)
•• HPV (human papillomavirus) screening test
•• Contraceptive devices (IUD) and family planning
•• Over-the-counter birth control (i.e., female condoms, sponges) with
a written prescription
•• BRCA genetic counseling for breast and ovarian cancer
•• BRCA genetic testing for breast and ovarian cancer*
Pregnant Women
Additional covered preventive services
•• Anemia screening
•• Bacteriuria urine tract infection screening
•• Breast feeding interventions (to support and promote
breast feeding before and after childbirth)
•• Hepatitis B Infection screening
•• Rh (antibody) incompatibility testing
•• Syphilis testing
•• Breast pumping
•• Gestational diabetes screening
Wait a minute—I thought that was covered?
Preventive vs. diagnostic testing
Your preventive benefits offer full coverage for many tests, screenings
and immunizations. During the exam, your physician may discover an
issue or problem that requires further testing or screening for an accurate
diagnosis. These additional diagnostic tests often require you to pay a
share of the costs.
* Contact Premera for a pre-service review to see if coverage is approved.
Continue reading for Children/Teens preventive services
Children | Teens
Suggested routine exams, immunizations and screenings
For children under age 18, routine exams, immunizations, and screenings listed below
are covered in full when received from a provider within your plan’s network.
Preventive services
•• Well baby exam—ages 0 to 3
•• Well child exams—ages 4 to 18
•• Annual alcohol and drug use
•• Anemia screening
•• Autism screening
•• Behavioral issues
•• Congenital hypothyroidism
(lack of thyroid secretions)
•• Cervical dysplasia
(for sexually active females)
•• Depression screening
•• Developmental screening
•• Hearing screening
•• Height, weight, and body mass (BMI)
•• HIV infection screening (for those at risk)
Immunizations
•• Diphtheria, tetanus, pertussis (DPT)
•• Influenza (flu)
•• Lead screening
(for children at risk of exposure)
•• Lipid disorders
(cholesterol and triglycerides)
•• Obesity screening and counseling
for weight loss
•• Oral health risk assessment
(completed during routine physical exam)
•• PKU (phenylketonuria inherited metabolic
deficiency, newborns)
•• Sexually transmitted infection (STI)
prevention counseling
•• Hemoglobinopathies or Sickle cell anemia
and trait (for newborns)
•• Tuberculin (TB) testing
•• Vision screening
Medications
and supplements
•• Haemophilus influenza type B (HB)
•• Iron supplements—over the counter,
liquid form only, children up to 1 year old
•• Hepatitis A
•• Fluoride—prescription only, ages 0 to 18
•• Hepatitis B
•• HPV (human papillomavirius)
•• Inactivated polio virus (IPV)
•• Measles, mumps, rubella (MMR)
•• Meningococcal (meningitis)
•• Pneumococcal (pneumonia)
•• Rotavirus
•• Varicella (chicken pox)
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