FAQs for Routine Adult Physical Exams

Most preventive services, including some cancer screenings, are included in your plan at no additional cost.* You may have to pay for services to check on an existing issue or diagnose a health concern. If your plan has a deductible, you’ll pay most medical costs, like labs, MRIs, and hospital stays until you meet your deductible. And some high tech radiology, like MRIs, may have a higher cost share. Please click here to check your plan cost information for more details. *Under certain conditions, costs may apply.

Most plans cover recommended preventive and travel immunizations without cost share. This includes but is not limited to: flu shots, travel immunizations, shingles (Shingrix) and meningococcal vaccine. Members can get their immunizations from an in-network provider or at an outpatient clinic. Members with pharmacy benefits with us may also be able to receive immunizations at retail pharmacy locations affiliated with Express Scripts®´ that offers vaccines.

All HMO Blue® and HMO Blue New EnglandSM members must get a PCP referral before seeing a specialist. Because your PCP knows your history and health care needs, he or she is best qualified to help you decide whether a specialist is needed. To determine your cost share for these services, please Click here. Blue Choice® and Blue Choice New EnglandSM members have the option to self-refer for covered services but may incur a higher out-of-pocket cost. Members on PPO plans do not require a referral to see a specialist. To determine your cost share for these services, please Click here.

With the Find a Doctor & Estimate Costs tool, you can search for your provider and see their tier. Please click here to view the Find a Doctor & Estimate Costs tool. When logged into the Find a Doctor tool results will populate according to your plan.

The need for referrals can vary by plan type and type of service. Tests that may not need a referral or authorization, may still require an order from a physician. Details for your plan can be found here (link to costs and benefits table).

Your well-being is our top priority. Most of our plans cover routine physical exams and immunizations at no cost to you with a provider contracted within your network. Please Click here to view your plan benefit information, and please Click here to view your plan benefit costs.

We're dedicated to your well-being. Our fitness benefit and/or weight-loss benefit can each save you and your family up to $150 per calendar year on qualified expenses. For more information on what's covered, or to submit for reimbursement, please click here to visit our Fitness and Weight loss page. Click to see what's covered by your plan, please Click here to view your plan benefit information, and please Click here to view your plan benefit costs.