WELLNESS CARE

This benefit is designed to prevent more serious and costly illnesses by providing coverage for routine health care.  The calendar year deductible does not apply to Wellness Care visits.  For a comparison of the wellness benefits provided by the Plan with those defined by the state statutes as comprehensive adult wellness benefits, contact the Department of Administration & Information, Human Resources Division/Employee Benefits.

Wellness benefits will be paid at 100%, up to $400 maximum per calendar year for each covered participant age 8 days and older and $600 maximum for the first year of life for covered children age 8 days  to 12 months.

When there is no symptom, illness or diagnosis, Wellness Care includes the following benefits:

• Flu shot

• Routine physical

• Mammogram

• Pap testing

• Screening services as part of the preventive exam

• Exam of heart, lung, and abdomen (includes camp/school physicals)

• Immunizations

• PSA testing

• Sigmoidoscopy

• Hemogram

• Special services such as hearing and vision tests, nutrition counseling, exercise and stress management, etc. when performed during a physical exam by a primary physician.

You may be notified by mail when it is time to schedule appointments for immunizations for children under 2, mammograms, Pap tests, and prostate screenings.

When there is no symptom, illness or diagnosis, benefits will also include (in addition to the $400 wellness care) the following:

• Colonoscopy - 100% of maximum allowable cost once every five (5) years NOTE: If any tissue or polyp is removed during the course of a Colonoscopy, the procedure changes from a routine procedure to a surgical procedure subject to deductible and coinsurance requirements.