Skip to Content

Preventive Care: What’s covered?

At Dean Health Plan (DHP), all of our coverage options emphasize a proactive preventive approach to care—one in which a primary care provider (PCP) oversees all aspects of an individual's healthcare needs and keeps them well through regular visits.

The Affordable Care Act and the recent government mandates have only stengthened DHP’s position on preventive care, and this philosophy is clearly reflected in the benefit packages offered as most preventive services are covered—and some at 100 percent. The complete list of services we cover as preventive is listed below by type and benefit year for your convenience.

To see your specific coverage details, please review your Member Certificate and Summary of Benefits.

List of Preventive Services.

Preventive Services with first dollar coverage include:

  • Routine vaccines for both adults and children
  • Flu and pneumonia shots
  • Preventive care visits for routine screenings and preventive services, including Well Baby and Well Child Visits
  • Blood pressure, cholesterol and diabetes screenings
  • Colorectal cancer screening for adults over 50
  • Breast cancer mammography screenings every one to two years for women over 40

 Frequently Asked Questions

  1. Are there any possible restrictions or exceptions to these services being covered at 100%?
  2. Are all mammograms covered as preventive?
  3. How are colonoscopies covered?
  4. Is IUD placement and removal covered as contraceptive?
  5. Will sterilizations for men now be covered under preventive?
  6. What happens if a member visits an out-of-network provider?
  7. Where can a member get a breast pump?

1. Are there any possible restrictions or exceptions to these services being covered at 100 percent?
Yes, there are certain benefits and services that contain frequency restrictions that may result in cost sharing. See Questions 2–4 for common examples. For further details, please review your Member Certificate and Summary of Benefits.

2. Are all mammograms covered as preventive?
Mammograms are covered as preventive at no cost to you. However, once you have a history of certain conditions, such as breast cancer, even if the condition is in remission or no longer causing you health issues, services related to that condition might not be considered preventive.

3. How are colonoscopies covered?
Colonoscopies are considered preventive services and therefore covered at no cost to you. Additionally, once you have a history of certain conditions, such as colorectal polyps or colon cancer, even if the condition is in remission or no longer causing you health issues, services related to that condition might not be considered preventive.

4. Is IUD placement and removal covered as contraceptive?
Because this is classified as a contraceptive, the placement of an IUD is covered. If the IUD needs to be removed because any problems arise, the removal will also be covered. Removal because of a change in contraception method is not covered.

5. Will sterilizations for men now be covered under preventive?
No, because contraceptive coverage only applies to women’s health, male sterilizations will remain covered under the surgical benefit. Please check your member certificate for applicable cost sharing.

6. What happens if a member visits an out-of-network provider?
A plan or issuer is not required to provide coverage for recommended preventive services delivered by an out-of-network provider.

7. Where can a member get a breast pump?
If a doctor writes a prescription for manual breast pump, it will be covered at 100 percent under members’ Durable Medical Equipment (DME) benefit when obtained from the approved DME supplier, Home Health United (HHU). Please visit the HHU website for locations or mail order information at homehealthunited.org.

Preventive or not? See our examples.

Are these services considered preventive?

Scenario 1:
As part of an annual wellness exam, a patient has a blood pressure screening, a screening lipid test and complained of a sore throat.

Partially Preventive.
    As part of a wellness exam a physician may order preventive screenings along with screenings necessary to treat or diagnosis a health condition. In this scenario the wellness exam, blood pressure screening and lipid screening would be payable as preventive, however, the patient would be responsible for any deductible, co-insurance, or copayment defined in their policy provisions for the strep culture, as this is a diagnostic test to address the sore throat.

Scenario 2:
A patient comes in for quarterly visits to the doctor for blood tests to check his/her cholesterol level and confirm the medication dosage level is appropriate.

Not Preventive.
    The quarterly blood tests are not considered preventive because they are being done to manage an already existing health condition.

Scenario 3:
A polyp is discovered and removed during a preventive colonoscopy. As a result, the physician recommends more frequent screenings.

Not Preventive.
    All future colonoscopies are considered diagnostic in nature, therefore, the patient would be responsible for any deductible, co-insurance or copayment defined in their policy provisions.

Scenario 4:
A seven-year-old child receives a vision screening at his/her annual Well Child visit.

Preventive.
    This service is preventive when it is part of the annual Well Child visit.

Scenario 5:
A woman comes in for her annual wellness exam. During her wellness exam, her physician recommends a mammography screening because she is over 40 years old and hasn’t had a mammogram yet.

Preventive.
    The requested mammography is preventive because it was part of her wellness exam, she meets the age requirements and guidelines for a preventive mammograms screening, and the mammogram was not prompted due to a previous diagnosis or symptom.

Scenario 6:
As part of a 38-year-old women’s preventive exam, her physician recommends a mammogram due to her family history of breast cancer.

Not Preventive.
    This mammogram would not be considered preventive as there is a family history present and the patient does not meet the age requirement of over 40 for a preventive mammogram.

Where to go: PCP, Urgent Care or ER?

Not sure where to go for care? Check out our Right Care page to learn about your options.

Find a Doctor

Find a DoctorFind a provider near your home, office or school. Dean Health Plan has networked with nationwide providers to serve members traveling or residing outside of Wisconsin.

Find a Doctor or Location

Dean On Call

If you're not sure you need to see a doctor, give us a call 24 hours a day, 365 days a year.

Experienced registered nurses at Dean on Call are always available to answer your health questions and concerns.

(608) 250-1393
(800) 57-NURSE
(1-800-576-8773)
* NOTE: Due to licensing regulations, Dean on Call's triage services are only available to residents of Wisconsin.