Health Care
Preventive Care (2009)
The Medical Plan provides preventive care coverage for each covered person
at 100% up to specified annual limits, with no deductible. Preventive care
includes things like health care, vision checkups and screenings.
Because keeping healthy is at the heart of living well, the Kraft Medical Insurance
Plan contains comprehensive coverage for preventive care services for adults and children.
Our coverage is designed around the guidelines recommended by the AMA, which are based on
the patient’s age and sex. Here are some examples:
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Annual exams and maintenance vaccines for adults like annual flu shots and periodic tetanus shots
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For men, PSA (prostate-specific antigen) screenings
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Well-child care like immunizations
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For women, PAP smears and mammograms (Women may choose both a primary care and OB/GYN visit if desired.)
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Colonoscopy
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Cholesterol screening/lipid panels
All three Medical Plan options cover preventive care at 100% with no deductible, up to $1,000 per person per year; the well-child maximum is $1,500 for the first 12 months of life and $1,000 each year thereafter while covered under the plan.
The in-network and out-of-network limits are combined; that is, the $1,000 limit applies whether the preventive care is received in-network or out-of-network.
To be paid correctly, provider must code claims appropriately: routine vs. diagnostic (Preventive care = routine codes. Non-preventive care = diagnostic codes).
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Colonoscopy and sigmoidoscopy (less invasive colonoscopy)
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PAP smear, mammogram, PSA (prostate-specific antigen) test, digital rectal exam (DRE) and cholesterol screening
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If billed as routine: Paid at 100% and do count toward the $1,000 annual preventive care limit.
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If billed as diagnostic (for example, a follow-up mammogram following a routine mammogram): Paid at 100% but do not count toward the $1,000 annual preventive care limit.
NOTE: Make sure your doctor bills services appropriately to ensure these expenses are paid correctly. Services billed as diagnostic are subject to deductible and co-insurance, except as noted above. Reasonable and customary limits apply to out-of-network care.
Once you reach the preventive care coverage limit, additional preventive care services are subject to the plan’s deductible and co-insurance provisions
Also consider …
Getting the Most Out of Your Preventive Care Benefit