Preventive Care FAQs

Are there any possible restrictions or exceptions to these services being covered at 100 percent?

Yes, there are certain benefits and services that contain frequency restrictions that may result in cost sharing. See Questions 2–4 for common examples. For further details, please review your Member Certificate and Summary of Benefits.

Are all mammograms covered as preventive?

Mammograms are covered under the diagnostic benefit in your certificate and are subject to a deductible and co-insurance, or other appropriate cost sharing per your policy, under diagnostic services. In some cases, if you meet the standard medical guidelines for the procedure (such as age, gender and frequency) the service might be eligible for coverage under your preventive benefit. Ultimately it depends on the exact procedure or service that is performed and whether it was done as a routine screening and not prompted by symptoms or complaints.

Additionally, once you have a history of certain conditions, such as breast cancer, even if the condition is in remission or no longer causing you health issues, services related to that condition might not be considered preventive.

How are colonoscopies covered?

Similarly to mammograms, colonoscopies are covered under the diagnostic benefit in your certificate and are subject to a deductible and co-insurance, or other appropriate cost sharing per your policy, under diagnostic services. In some cases, if you meet the standard medical guidelines for the procedure (such as age, gender and frequency) the service might be eligible for coverage under your preventive benefit. Ultimately it depends on the exact procedure or service that is performed and whether it was done as a routine screening and not prompted by symptoms or complaints.

Additionally, once you have a history of certain conditions, such as colorectal polyps or colon cancer, even if the condition is in remission or no longer causing you health issues, services related to that condition might not be considered preventive.

Is IUD placement and removal covered as contraceptive?

Because this is classified as a contraceptive, the placement and removal of an IUD is covered. 

Will sterilizations for men now be covered under preventive?

No, because contraceptive coverage only applies to women’s health, male sterilizations will remain covered under the surgical benefit. Please check your member certificate for applicable cost sharing.

What happens if a member visits an out-of-network provider?

A plan or issuer is not required to provide coverage for recommended preventive services delivered by an out-of-network provider.

Where can a member get a breast pump?

If a doctor writes a prescription for manual breast pump, it will be covered at 100 percent. Please visit the Green Bay Home Medical website for locations or mail order information.