Preventive Benefits

The wellness/preventive services payable by this plan are designed to comply with terms of the Patient Protection and Affordable Care Act (PPACA), the current recommendations of the United States Preventive Services Task Force, the Health Resources and Services Administration, and the Centers for Disease Control and Prevention.

The benefit levels on the current preventive-benefit menu apply when provided by a network provider. If non-network providers are used, the member is subject to deductible, co-insurance, non-network differential charges, and any charges beyond MUST’s allowable limits. Non-network differential charges and charges beyond MUST’s allowable limits (often referred to as balance billing) do not apply to member deductibles and out-of-pocket maximums.

When both preventive services and diagnostic or therapeutic services occur during the same visit, a member pays deductibles and co-insurance for diagnostic or therapeutic services but not for the preventive services. When a preventive visit turns into a diagnostic or therapeutic service in the same visit, then deductibles and co-insurance will apply to the diagnostic or therapeutic service. Claims submitted outside the recommended frequency limits will be subject to deductible and co-insurance.