Which Preventive Care Services Are Covered at 100%?

Under LifeX group health benefit plans, preventive care services are covered at 100% when you stay in network—meaning no cost to you for those visits. This includes routine screenings like annual mammograms and colonoscopies. The key condition is that the care happens in network; going out of network for these services can leave you with a balance.

What "covered at 100% in network" means

For preventive services, you don't have to meet your deductible first. A common question is whether a routine mammogram or colonoscopy requires hitting the deductible before it's covered—the answer is no, as long as the service is performed in network. These services are paid at 100% of the allowable amount up front.

"100% of allowable" is worth understanding: it means the plan pays the full defined amount for an approved preventive service when performed in network. The services that qualify, and the allowed amounts, are defined in your Summary of Benefits and Coverage.

The in-network catch

The 100% coverage applies to in-network care. If you receive a preventive service from an out-of-network provider, you could end up with a balance. So before scheduling a screening, it's worth confirming your provider participates in the network—our guide on checking the PHCS PPO network walks through how to do that in a couple of minutes.

Minimum essential coverage

Preventive care ties into what's called minimum essential coverage (MEC). Preventive services and MEC are covered at 100% in network under these plans. We explain what MEC is, and how it differs from comprehensive major-medical coverage, in our separate guide on that topic—worth reading if you're trying to understand exactly what these benefits do and don't include.

The bottom line

Routine preventive screenings are covered at 100% when performed in network, with no need to meet your deductible first. Confirm your provider is in network before your visit, and check your Summary of Benefits and Coverage for the full list of services that qualify.

This article explains how preventive coverage generally works and is not a description of any specific plan's benefits. For the services and amounts that apply to you, see your Summary of Benefits and Coverage and plan documents.