MMC Benefits Handbook
Preventive/Wellness Care
How is preventive/wellness care covered?
The Plan covers Preventive/Wellness Care at:
What services are considered preventive/wellness care?
The Plan considers physician, testing and diagnostic fees for the following specific wellness expenses to be preventive/wellness care:
  • Pediatric preventive care services, developmental assessments, and laboratory services appropriate to the age of a child from birth to age six, and appropriate immunizations up to age 18.
  • Coverage includes at least five child health supervision visits from birth to 12 months, three child health supervision visits from 12 months to 24 months, and once-a-year visits from 24 months to age six.
  • Routine physical exams.
  • Routine screenings for certain cancers and other conditions.
  • Routine screening colonoscopy is covered as preventive with a diagnosis of family history.
  • Routine immunizations. Age limits may apply.
  • Routine lab tests, pathology, and radiology.
  • Hearing and vision screening limited to one exam per Plan Year for children up to age of 21.
  • Routine pre-natal and post-natal services.
  • One routine postnatal care exam provided during the period immediately after childbirth that includes a health exam, assessment, education, and counseling.
  • Preventive contraceptive methods and counseling for women.
    • Includes certain approved contraceptive methods for women with reproductive capacity, including contraceptive drugs, devices, and delivery methods.
Not all preventive services are listed above. Contact the Claims Administrator for specific details on preventive services.
Does the Plan cover outpatient physician services?
The Plan covers charges for outpatient office visits at:
  • $5 to $40 copay / visit (PCP and Mental Health/Substance Use Disorder Out Patient provider) (based on provider and location) or $5 to $40 copay / visit (Specialist) per in-network office visit (based on provider and location) and $120 copay / visit for out-of-network providers.
Does the Plan cover gynecology visits?
The Plan covers one routine gynecological exam each calendar year at:
  • 100% for in-network providers and $60 copay / visit for out-of-network providers.
If the visit to the gynecologist is for treatment of a medical condition, it is not considered routine care and will be covered at:
  • $5 to $40 copay (PCP) per office visit (based on provider and location) for in-network providers $120 copay / visit for out-of-network providers.
Does the Plan cover mammograms?
The Plan covers routine mammograms (including 3D mammograms) at:
  • 100% for in-network providers and out-of-network providers.
There are no age or frequency limitations. It is recommended that members follow the American Cancer Society guidelines for age and frequency to determine when to receive preventive care services.
Does the Plan cover Pap smears?
The Plan covers one routine Pap smear each calendar year at:
  • 100% for in-network providers and $60 copay / visit for out-of-network providers.
If your doctor recommends a non-routine Pap smear as a follow up to a medical diagnosis, the Plan covers the visit at:
  • $5 to $40 copay / visit (based on provider and location) for in-network providers and $120 copay / visit for out-of-network providers.
Does the Plan cover prostate specific antigen (PSA) tests and routine Annual Digital Rectal exams?
The Plan covers routine prostate specific antigen (PSA) tests for covered males (age 40 and older) and routine Annual Digital Rectal Exam (DRE).
  • 100% for in-network providers and $60 copay / visit for out-of-network providers.
If your doctor recommends a non-routine DRE test as a follow-up to a medical diagnosis, the Plan covers your DRE test at:
  • $5 to $40 copay / visit (based on provider and location) for in-network providers and $120 copay / visit for out-of-network providers.