Preventive Care Services
CarePlus will reimburse certain program participants, those who are not enrolled in any other plan or program which provides any coverage for preventive care, for the cost of preventive care services. Preventive care services are those covered services that are determined by the benefits administrator to provide preventive care and are included in the benefits administrator’s preventive care policy. Preventive care services are covered at 100 percent of the allowed charge, without participant cost sharing. Coverage is provided for preventive care drugs under the expanded CarePlus benefit but only as described in the “Preventive Care Drugs” section below.
Preventive Care Drugs
The drugs that are covered by the program at 100 percent of the allowed charge as preventive care drugs are determined by the benefits administrator based on the requirements of the PPACA. The medications covered under the preventive care drugs provisions will change from time to time, as new medical evidence emerges and evidence-based recommendations change. The drugs considered preventive care drugs in some circumstances may also be provided for purposes other than routine preventive care. When this occurs, these drugs are not covered as preventive care drugs by the program.