This health plan covers routine physical exams furnished by a General Hospital, Community Health Center, Physician, Nurse Practitioner or Independent Lab. These covered services include:
Routine immunizations (including hepatitis A and B for members with increased risk or family history, flu shots, pneumococcal vaccine and Lyme disease booster).
This health plan covers routine GYN exams, including routine Pap smear tests, furnished by a General Hospital, Community Health Center, Physician, Nurse Practitioner or Independent Lab.
Routine medical exams for a member age 19 or older. This includes: history and risk assessment; chest x-ray; EKG, urinalysis; basic and comprehensive metabolic panel; complete blood count; fecal occult blood test; prostate-specific antigen blood test; chlamydial infection test; and fasting lipoprotein profile.
Treatment to repair and/or replace sound, natural teeth damaged due to accidental injury. These benefits include dental accident treatment, follow-up care, dental crowns and dental prostheses (such as dentures, bridges, braces and other such dental appliances). No benefits are provided for dental care following an injury caused by biting or chewing.
This health plan covers outpatient dialysis services furnished by a General Hospital, Community Health Center, Free-standing Dialysis Facility or Physician.
Diagnostic lab tests furnished by a General, Rehabilitation or Mental Hospital, Surgical Day Care Unit, Ambulatory Surgical Facility, Community Health Center, Independent Lab, Physician or Nurse Practitioner. These tests also include diagnostic machine tests such as pulmonary function tests and holter monitoring.
Diagnostic x-ray and other imaging tests furnished by a General, Rehabilitation or Mental Hospital, Surgical Day Care Unit, Ambulatory Surgical Facility, Community Health Center or Physician. These tests also include diagnostic imaging tests by a Free-standing Diagnostic Imaging Facility.