Preventive Care Coverage: 

For active employees and non-Medicare retirees

Many of the recommended preventive services provided are covered by the State Employee Health Plan and are at no cost to you when the services are performed by an in-network provider. Although it is important to coordinate your care with your primary care doctor, referrals are not required for these services.

Routine Physical Exams:  Routine physicals for adults & children are covered at 100% with no copay with your named Aetna primary care physician (PCP).  There is no coverage for these exams if you go outside of the Aetna network.  The age and frequency limits of these visits are:

Unlimited birth to age 18
One every 12 months Age 18 and over

Routine Eye Exams:  These exams are covered at 100% with no copay once per calendar year when provided by an in-network doctor. The coverage for an out-of-network provider is 60% after the deductible has been met.

Routine Gynecological Care Exams:  These exams are covered at 100% with no copay at both the in-network and out-of-network benefit level. 

Immunizations:  Immunizations recommended by the American Medical Association are covered at 100% with no copay when given by an in-network provider.  There is no coverage for immunizations if you go outside of the Aetna network.

Routine Mammograms:  Mammograms are covered at 100% with no copay at both the in-network and out-of-network benefit level. There are no age or frequency limits.

Colorectal Cancer Screenings:  The coverage for routine and medically necessary screenings is 100% no deductible with a referral from your PCP to an in-network provider.  The coverage to an out-of-network provider is 60% after the $2,500 self-referred deductible.  There are no age or frequency limits.

Routine Digital Rectal Exam/Prostate-Specific Antigen Test:  One exam per calendar year is covered at 100% no deductible with a referral from your PCP to an in-network provider.  There is no coverage for these exams if you go outside of the Aetna network.

State of Maine Statute: Title 5 285, 285-A and 286