$600.00 goes towards expenses incurred for preventive/routine care services per eligible and active Diamond/Platinum person per Calendar Year after you have paid your office visit Copayment(s).
The following services are under the Preventive/Routine Care Benefit when no diagnosis is present and may be subject to the office visit Copayment and/or Coinsurance. Please see your Plan Benefit Binder for additional information.
- Immunizations, adults and children age 6 and over
- Annual Physical/Gynecological Exams
- Pap Smears
- Pulmonary Function Tests
- Sigmoidoscopy
- Treadmill Stress Test
- Electrocardiogram (EKGs)
- Flu Vaccinations/P
- Audiometry
- Bone Density
- Chest X-Rays
- Comprehensive Labs, including urinalysis
- Virtural Testing. Including capsule endoscopy
- Genetic Testing for a family or ancestral history of disease
After the Trust has paid the $600.00 annual Maximum Benefit for Preventive/Routine Care, no further payment will be made by the Trust on any of the above-listed services incurred during the remainder of the Calendar Year.
*Immunizations provided by the Clark County Health District will not be applied to the Out-of-Network deductible. The participle is responsible for 20 percent Coinsurance of the Eligible Medical Expenses (EME) and any amount over the EME for both Diamond and Platinum Plans. All other covered services provided by the Clark County Health District will be processed according to the Out-of-Network benefits listed in the Plans Benefit Binder.
The services indicated below are also considered Preventive/Routine Care. These services are not limited to the $600 Maximum Benefit.
- Routine circumcision
- Well baby services, up to age 6, including physical examinations and routine administration of childhood vaccinations as recommended by the Center for Disease Control (CDC)
- Mammograms - See Breast Cancer Awareness Campaign
- Digital Rectal Exams (DREs) and Prostate Specific Antigen (PSAs) – See Prostate Cancer Awareness Campaign