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You don't have to meet your medical deductible before the plan pays for services covered under the preventive care benefit.
- You pay nothing for preventive services when you see a network provider.
- If you see a non-network or out-of-network providers, you pay 50 percent of the allowed amount. Out-of-network providers may balance bill you.
- If you do not have access to a network provider for preventive services, the plan may pay 100 percent of billed charges. See page 20 of your network's certificate of coverage for how to request a network consent.
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.
- 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.
- 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:
- UMP Plus Puget Sound High Value Network: Family Planning Services, Mammograms, and Obstetric and Newborn Care.
- UMP Plus UW Medicine Accountable Care Network: Family Planning Services, Mammograms, and Obstetric and Newborn Care.
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.
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:
- Network provider.
- Network vaccination pharmacy. To find one, visit the Find drugs page or call Washington State Rx Services at 1-888-361-1611.
- Public health department.
The plan does not cover immunizations for travel or employment, even when recommended by the CDC or required by travel regulations.
Uniform Medical Plan
Business hours: Monday–Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. Pacific Time