Preventive Care Coverage

For active employees and non-Medicare retirees

Many of the recommended preventive services provided are covered by the State of Maine Health Plan and are at no cost to you when the services are performed by an in-network provider unless stated otherwise. Although it is important to coordinate your care with your primary care doctor, referrals are not required for these services. For more information regarding the coverage effective July 1, 2018, see the Anthem Preventive Care flier (pdf).

Routine Physical Exams: Routine physicals for adults & children are covered at 100% with no copay with an in-network provider.

Routine Eye Exams: These exams are covered at 100% with no copay once per calendar year when provided by an in-network doctor.

Routine Gynecological Care Exams: These exams are covered at 100% with no copay when provided by an in-network doctor or specialist.

Immunizations: Immunizations recommended by the American Medical Association are covered at 100% with no copay when given by an in-network provider. For more information, the Centers for Disease Control and Prevention (CDC) recommended schedules for the current year can be found here: from birth through age 6, from age 7 through 18 and for adults.

Mammograms: Screening and diagnostic mammograms are covered at 100% with no deductible at both the in-network and out-of-network benefit level.

Colorectal Cancer Screenings: The coverage for routine and medically necessary screenings is 100% no deductible.

Routine Digital Rectal Exam/Prostate-Specific Antigen Test: One exam per calendar year is covered at 100% no deductible. There is no coverage for these exams if you go outside of the Anthem network.

Lung Cancer Screening: Lung cancer screenings are provided for eligible members at no cost. To learn more about the eligibility requirements, visit the U.S. Preventive Services Task Force website.