What are my preventive care benefits?
HealthPartners firmly believes preventive care is a vital part of your healthcare. But you
can't take advantage if you don't know what your preventive care benefits are. Find out
How much will preventive care cost me? Most plans cover preventive care at
100 percent at network providers. Before your visit, visit healthpartners.com or
call Member Services to confirm your benefit level.
What is covered under my preventive care benefits? Preventive care benefits
cover, but are not limited to:
o Physical exams
o Well child appointments
Your doctor may also recommend other preventive care, including cancer screenings,
based on your age, medical history and family history. Cancer screenings are often
considered preventive care; however they can be billed as an office visit under certain
circumstances (see below). If additional tests or appointments are required as a result of a
preventive care visit, those will be billed as standard office visits.
When is an office visit not preventive care? An office visit is not preventive
care when it is scheduled to treat a specific illness or to check on a chronic
condition. For example, if you go to the doctor because you have a sore throat or
for a follow-up visit after a high blood pressure diagnosis, the service is not
If something is diagnosed during the preventive visit, is it still considered
preventive? In most cases, when a diagnosis is involved, the visit is not
considered preventive care and will be billed as an office visit. You may want to
confirm the type of care you are receiving with your doctor's office at your
Is lab work taken during preventive visits covered 100 percent? Routine lab work
may be covered during your visit. For example, if the doctor tests your cholesterol
as part of your preventive visit, it will be covered as preventive care. If your
doctor tests your cholesterol because you have a history of high cholesterol, or to
check your response to high cholesterol treatment, then it may not be covered as
preventive care since it was previously diagnosed.
How does HealthPartners know when a visit is preventive care? Your doctor's
office will tell HealthPartners what type of care you received based on how they
bill the visit. It is possible that they may bill part of your visit as preventive and
part of the visit as an office visit. This billing information from your doctor's
office determines your benefits for the visit.
If you're a HealthPartners member with specific questions on your preventive care
benefits, call HealthPartners Member Services, Monday through Friday, 7 a.m. to 7 p.m.
CST, at 952-883-5000, 1-800-883-2177 or 952-883-5127 (TTY).
The HealthPartners family of health plans are underwritten and/or administered by
HealthPartners, Inc., Group Health, Inc., HealthPartners Insurance Company or
HealthPartners Administrators, Inc. Fully insured Wisconsin plans are underwritten by
HealthPartners Insurance Company.