Preventive care

Preventive care for UMP Plus

For complete information: Read the "Preventive Care" section in your Puget Sound High Value Network or UW Medicine Accountable Care Network certificate of coverage.

You don't have to meet your medical deductible before the plan pays for services covered under the preventive care benefit.

For a list of services covered as preventive, visit Healthcare.gov. This site also features links to specific preventive services covered for women and children. Note that recommendations added during the calendar year may not be covered as preventive until later years.

    Examples of services covered as preventive care

    • Preventive visits such as well-baby care and annual physical exams.
    • Preventive vision acuity screening from birth through 18 years of age.
    • Intensive behavioral counseling for adults who are overweight or obese and have additional cardiovascular disease risk factors.
    • Screening for hepatitis B for non-pregnant adolescents and adults at high risk.
    • Routine screenings for women (see list below for examples).
    • Certain radiology and lab tests such as screening mammograms.
    • Screening procedures such as colonoscopy; see page 53 in your network's certificate of coverage for coverage of colonoscopy performed to diagnose or treat disease or illness.
    • One-time screening by ultrasound for abdominal aortic aneurysm, for men ages 65-75 who have ever smoked.
    • Immunizations as explained below.
    • Hearing tests as part of a newborn screening.
    • Fluoride for prevention of caries (dental decay): prescribed by primary care provider to children age 6 months and older, when water is fluoride deficient; see page 97 for more information about this coverage and page 49 for coverage of fluoride varnish in your network's certificate of coverage
    • Certain screening tests performed during pregnancy; see pages 68-70 in your network's certificate of coverage for more on prenatal care.  

    You may call Uniform Medical Plan at 1-888-849-3681 to ask if a service is covered as preventive. 

    Preventive services specifically for women

    • Human Papillomavirus (HPV) testing for women ages 30 and over, once every three years.
    • Chlamydia and gonorrhea testing in sexually active women age 24 years and younger, and for women age 25 and older who are at increased risk for infection.
    • Education and counseling regarding contraception.
    • Counseling and screening for HIV; counseling and screening for interpersonal and domestic violence; and counseling for sexually transmitted infections.

    For additional services covered as preventive for women, read the following sections in your network's certificate of coverage:

    Note: Prostate cancer screening (prostate-specific antigen [PSA] testing) is not covered under the preventive care benefit, but is covered as a medical benefit (subject to the medical deductible and coinsurance).

    ALERT! Follow-up visits or tests, or other services that are not preventive received during preventive care visits, are not covered under the preventive care benefit.

    Covered immunizations

    The plan covers immunizations as included on the applicable immunization schedule (children, adolescents, adults) for U.S. residents by the Centers for Disease Control and Prevention (CDC). See the lists of covered immunizations, or call Uniform Medical Plan at 1-888-849-3681.

    Immunizations covered under the preventive care benefit are not subject to the medical deductible. Immunizations given by the providers listed below are paid under the preventive care benefit. If you see a non-network or out-of-network provider for covered immunizations, you pay 50 percent of the allowed amount; an out-of-network provider may balance bill you.

    Tip: Flu shots are covered as included on the applicable CDC immunization schedule.

    Where can I get immunizations?

    Immunizations covered under the preventive care benefit are free when received from a:

    The plan does not cover immunizations for travel or employment, even when recommended by the CDC or required by travel regulations.

    Contact

    Uniform Medical Plan
    Phone: 
    1-888-849-3681 
    TTY: 711
    Business hours: Monday–Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. Pacific Time