When a In-network provider is used, all preventative care services (as defined under the Affordable Care Act) will be covered at 100% (at no cost to the covered individual). No coverage will apply to Out-Of-Network providers.
- Physical examinations,
- Blood tests,
- Pap Smears,
- Smoking cessation programs, and
- Other routine services and covered supplies that contribute to maintaining your wellness, if approved in advance by the Fund Office, and are not covered elsewhere under the Plan. A request for such pre-approval constitutes a pre-service claim. See the Pre-service Claims section.
You do not need to pay a deductible or copayment for these benefits and you may use either PPO or non-PPO healthcare Providers.
Wellness benefits are provided only for you and your spouse and are not provided for your Dependent Children. However, Inpatient nursery charges, routine Physician examinations and routine immunizations are covered under the Comprehensive Major Medical Benefit for your eligible Dependent Children up to the age of 26. See Covered Expenses.
Please note that wellness benefits will only be paid when your Physician uses a diagnosis code that qualifies for reimbursement under the Fund. For more information, please contact the Fund Office.