Preventive Care


Your medical plan covers routine in-network preventive care for you and your dependents at 100%. Preventive care service are free to you when you use an in-network provider, or if you live in an area where a network is not available.


Services include:

  • routine physical exams at any age, including medical history, prostate exam, proctosigmoidoscopic exam, pelvic exam, breast exam, weight/height, blood pressure, total cholesterol, urinalysis, blood glucose, and EKG
  • well-baby care
  • routine gynecological exam and Pap smear
  • routine mammogram at any age, if recommended by a doctor
  • routine hearing screening for preventive purposes
  • immunizations administered in a doctor's office or health care facility, except immunizations for the sole purpose of travel outside the United States


Additional services as of January 1, 2013

These wellness services mandated by health care reform went into effect January 1, 2013:

  • screening for gestational diabetes
  • breastfeeding supplies
  • contraceptive sterilization -- tubal ligation
  • contraceptive drugs and devices without a generic equivalent (100% coverage)


Note: As part of your annual physical, your doctor may order a test that is not part of your preventive benefit. That means you could end up being responsible for a portion of the bill.


Or, if you already have a chronic condition like diabetes or high blood pressure and your doctor writes a prescription or orders a blood test specific to that condition, the visit will not be considered a routine exam. There will be a diagnosis code filed with the claim and you will be billed for some or all of the costs for that visit.


To help avoid surprises, let your doctor know what tests are covered under your preventive benefit prior to performing tests. You can find this information on the Highmark website:


Also, ask your doctor’s office staff to code the visit as a preventive service when appropriate, to ensure that the claim is processed correctly at the 100% coverage level. If you are unsure if your claim was processed correctly, call the number on the back of your medical ID card and speak to a representative.