Essential health benefits Defined as the 10 categories of common benefits that are deemed essential,** these Essential Health Benefits can’t be subject to dollar limits, either annually or on a lifetime basis. Depending on the type of plan you purchased, services associated with Essential Health Benefits may still require cost sharing in the form of copays, coinsurance, and deductibles. These include: • Preventive*, wellness, and disease management services • Emergency care • Hospitalization • Ambulatory care • Maternity and newborn services • Prescription drug coverage • Pediatric services† • Laboratory services • Rehabilitative and habilitative services
Preventive services At the heart of our preventive care is a holistic care philosophy that you’ll get the support needed to remain healthy and enjoy life. We provide the following preventive services with no copays, coinsurance, or deductibles:* • Annual Preventive Office Visit, which includes important preventive services • Screenings for breast, cervical, and colon cancer • Cholesterol screenings • Routine vaccinations for adults and children • And more services Visit Prevea360.com/PreventiveCare or call the customer care center at 1 (877) 230-7555 (TTY: 711 ) for a comprehensive list of covered preventive services.
Review our glossary of common terms at Prevea360.com/InsuranceTerms
• Mental health and substance use services, including mental health treatment
* No cost share responsibilities apply when services are delivered by a network provider, and when all preventive services criteria are met. Visit Prevea360.com/PreventiveCare for a comprehensive list of covered preventive services. ** A ll small group plans (2–50 employees) cover Essential Health Benefits. However, if you work for a larger employer (51+ employees) your benefits may vary. Contact your human resources, benefits administrator, or benefits department for information about your specific coverage. † Prevea360 Health Plan does not offer pediatric dental services. This coverage is available on the Health Insurance Marketplace ( Healthcare.gov ) and can be purchased as a stand-alone product. Please contact your benefits administrator or the Marketplace to purchase pediatric dental coverage or a stand-alone dental services product.
Visit Prevea360.com or call 1 (877) 230-7555 (TTY: 711 ) | 17
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