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Benefits • Medical • Wellness Benefits

Wellness Benefits include routine physical exams (no limit on visits), routine diagnostic tests (lab and x-ray), routine eye exams (includes contact lens fitting and refractions) and routine hearing exams.

The PPO plans pays 100% of covered routine preventive expenses.

   • Preventive exams not subject to deductible.
   • $750 maximum per year per covered member.
   • Charges above $750 will be applied to deductible and coinsurance.

Additional expenses are not subject to deductible and maximums:
   • Immunizations other than for foreign travel.
   • Age-related tests (sigmoidoscopies, colonscopies and bone
      mineral density testing).

Examples of Routine Preventative Care

Routine Physical Exame	Annual Prostate Exam
Blood Pressure Screening	Flu Shot (Influenza Immunization)
Annual Mammogram	Annual Fasting Blood Sugar Test
Clinical Breast Exam	Annual Cholesterol Test
Annual Pap Smear	Tetanus-Diphtheria Booster
Well-Baby Care	Routine Lab (Blood & Urine) Testing

Contact BlueCross BlueShield for more information on Wellness Benefits or check out the Benefits Guide.

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