Getting an annual checkup and other preventive care exams is one of the easiest ways to protect your health and detect problems early on when they're easier to treat. UMP plans cover a wide variety of preventive services with no copay, no coinsurance, and no deductible, meaning no out-of-pocket costs to you when you see a provider in your plan's network. Learn more about why you should choose network providers.
What's covered?
Here are a few examples of covered preventive care:
- Annual physical exam
- Blood pressure screening
- Screening mammograms and Digital Breast Tomosynthesis (DBT) for members ages 40 and older
- Screening mammograms and DBT for members under age 40 at an increased risk for breast cancer
- For members under age 40, a covered health care provider must order the service, and the claim must be billed with an "at risk" diagnosis to be covered under the preventive care benefit.
- Cervical cancer screening (pap smear)
- Covered immunizations
- To find out which immunizations are considered preventive, check the Centers for Disease Control (CDC) immunizations schedules.
- For preventive prescription drugs, refer to the Preferred Drug List (PDL) or call ArrayRx
See the full preventive care list on HealthCare.gov or call UMP Customer Service to ask if a service is covered as preventive. Note that recommendations added during the calendar year may not be covered as preventive until later years.
What you will pay
- You pay $0 for covered preventive services when you see a provider in your plan's network. If you see an out-of-network provider, you will pay the out-of-network rate, plus any amount charged by the provider above the plan's allowed amount (exceptions may apply - see your certificate of coverage for more information). Follow-up visits or tests are not covered under the preventive care benefit.
- You pay $0 for covered preventive immunizations when received from a provider in your plan's network, network pharmacy, or public health department. The plan does not cover immunizations for travel or employment, even when recommended by the CDC or required by travel regulations.
- You pay $0 for covered preventive drugs when you fill your prescription at a network pharmacy. If you fill your prescription at an out-of-network pharmacy, you will need to submit a claim and you will pay the difference between the allowed amount and what the pharmacy charges (exceptions may apply - see your certificate of coverage for more information). Prescriptions purchased from an excluded pharmacy will not be covered.
ArrayRx is a separate company that provides pharmacy services.