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Preventive services

Preventive services are covered services provided for overall health maintenance such as routine health/wellness exams and tests, vaccinations, well-baby care and well-child care.

HealthChoice covers qualifying preventive care services at 100% of allowable fees for members who meet clinical criteria. When using a HealthChoice network provider, members have no out-­of-pocket cost, though there may be exceptions, limitations or clinical criteria to qualify for these services at no cost. Additionally, if services received during a preventive care visit are for something other than qualifying preventive care, the member will be responsible for the out-of­-pocket cost.

In addition to Affordable Care Act specific requirements, HealthChoice follows the recommendations of the United States Preventive Services Task Force and the American Academy of Pediatrics Bright Futures for the basis of coverage and criteria.

Providers are encouraged to review the HealthChoice Preventive Services list for any updates, code changes or the addition/deletion of previously listed codes.

For more details on qualifying preventive care services, visit the HealthChoice Preventive Services webpage or contact Customer Care at toll-free 800-323-4314. TTY users call 711.

Last Modified on May 14, 2021
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