Certain Preventive Services* May Be Covered at 100%
As a member of the Texas Employees Group Benefits Program (GBP), you already enjoy comprehensive health coverage funded by the State of Texas. The Affordable Care Act will add even more benefits for you and your family.
Starting September 1, 2011, certain preventive services* will be covered at 100% when you use a network provider. This means that you will not have to pay anything for certain preventive office visits, blood tests, certain radiological procedures, shots, and other services listed below. Preventive care follows health screening guidelines. Before the Affordable Care Act, you may have had to pay a portion of the cost.
If you see a provider for preventive services, and receive diagnostic treatment, your visit may not be considered preventive and you may be charged a copay or copay plus coinsurance, depending on your provider's billing practices.
* Under the Affordable Care Act, certain preventive health services are paid at 100% (i.e. at no cost to the participant) dependent upon physician billing and diagnosis. In some cases, you will still be responsible for payment on some services.
If you are an out-of-area participant, a retiree with Medicare as your primary coverage, or a return-to-work retiree with Medicare who continues retiree benefits, you do not need referrals to specialists.
However, if you are an in-area participant, remember to get a referral before you see a specialist in order to receive network benefits. If you access preventive services from a specialist who is not your primary care physician (PCP), you still need a referral from your PCP. Exceptions include visits to a network OB/GYN, retail health clinic or urgent care clinic, and when you see an eye doctor for a routine eye exam.
| Children and Adolescents | ||
|---|---|---|
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Newborns
Immunizations
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Childhood Health Screenings
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| Adults | ||
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General Health Screenings
Cancer Screenings
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Health Counseling
Immunizations
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Men
Women
Pregnant Women
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