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Teachers Retirement System

Covered Preventive Care Services

TRS-Care Pays 100% When Using In-Network Providers

Effective Sept. 1, 2016

TRS-Care encourages you to maintain health and wellness through routine “preventive” care. Preventive care means taking good care of yourself by participating in routine health check-ups and screenings for common ailments. Not only do these activities contribute to longevity and healthy living, you will realize significant financial savings in the long run. Going to the doctor regularly can help you catch potential health problems before they get too serious – and TRS-Care will pay 100% of in-network office visits and lab tests for preventive care.

Be sure your health care provider is aware that they must bill this benefit as “preventive care.” For example, a blood pressure screening is covered at 100 percent but if the screening is for the purpose of monitoring an existing condition, or to get a prescription, it may be billed as “diagnostic” instead. For diagnostic procedures you would be responsible for paying out of pocket until you meet your deductible.

Your plan provides preventive care benefits for covered services, when using network providers, and the services will not be subject to copayment, deductible, coinsurance or dollar maximums:

Important Tips for Using Preventive Care

  • Make sure that the preventive service you are receiving isn’t to diagnose or treat a condition.
  • Ask your health plan or doctor if a service is preventive or diagnostic. Your out-of-pocket costs will be higher for diagnostic services.
  • Use preventive care services like annual checkups to get and stay healthy.
  • Get a flu shot every year – it saves lives and prevents suffering.
 
  • Preventive care services may change as USPSTF, CDC and HRSA guidelines are modified. The chart below shows a list of common covered preventive services.
  • Services marked with an asterisk (*) are covered as preventive care for TRS-Care Medicare Advantage participants.
  • Certain services are only covered as preventive care for participants with certain risk factors or diagnoses. For example, TRS-Care Medicare Advantage participants with a history of smoking can receive lung cancer screening.
  • Preventive services from a out-of-network provider are subject to any applicable deductible and coinsurance.
List of Covered Preventive Care and Screenings
Adults
Women
  • Osteoporosis screening age 65 or older or with similar risk
  • Chlamydia infection screening
  • Gonorrhea and syphilis screening
  • BRCA counseling about genetic testing
Pregnant Women
  • Folic acid supplements
  • Anemia screening for iron deficiency
  • Tobacco cessation counseling
  • Syphilis screening
  • Hepatitis B screening
  • Rh incompatibility blood type testing
  • Bacteriuria urinary tract infection screening
  • Breastfeeding education
Men
  • Abdominal aortic aneurysm one-time screening in men ages 65 to 75 years who have ever smoked
Cancer screenings
  • Breast cancer mammography for women age 40 and older
  • Breast cancer chemoprevention counseling
  • Cervical cancer pap test for women
  • Colorectal cancer screenings including fecal occult blood testing, sigmoidoscopy or colonoscopy, for adults at age 50 until 75
  • Prostate cancer (PSA) screening for men age 40 and over
List of Covered Preventive Care and Screenings
Adults
General Health Visits and Screenings
  • Annual wellness visit
  • Annual routine physical exam for participants with Medicare Part B
  • “Welcome to Medicare” one-time preventive visit for new participants with Medicare Part B Blood pressure screening
  • Cholesterol screening
  • Type 2 diabetes screening
  • HIV and sexually transmitted infections (STIs) screenings
  • Annual glaucoma screening*
  • Cardiovascular testing every 5 years*
  • Annual lung cancer screening*
Health Counseling

Doctors are encouraged to counsel patients about these health issues and refer them to appropriate resources as needed:

  • Healthy diet
  • Weight loss
  • Tobacco use
  • Alcohol misuse
  • Depression
  • Prevention of sexually transmitted infections (STIs)
  • Use of aspirin to prevent cardiovascular disease
  • Diabetes self-monitoring training*
  • Kidney disease education services*
  • Medical nutrition therapy*
Immunizations
  • Hepatitis A and B
  • Herpes Zoster (Shingles)
  • Human Papillomavirus (HPV)
  • Influenza (Flu)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal (pneumonia)
  • Tetanus, Diphtheria, Pertussis
  • Varicella (chickenpox)

 

List of Covered Preventive Care and Screenings
Children and Adolescents
Newborns
  • Screening for hearing loss
  • Hypothyroidism
  • Sickle cell disease
  • Phenylketonuria (PKU)
  • Gonorrhea
  • Preventive medication for eyes
Immunizations
  • Diphtheria, Tetanus, Pertussis
  • Haemophilus influenzae type B
  • Hepatitis A and B
  • Human Papillomavirus(HPV)
  • Influenza (Flu)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal (pneumonia)
  • Inactivated Poliovirus
  • Rotavirus
  • Varicella (chickenpox)
Childhood health screenings
  • Medical history for all Children throughout development
  • Height, weight and Body Mass Index (BMI) measurements
  • Developmental screening
  • Autism screening
  • Behavioral assessment
  • Vision screening
  • Oral health risk assessment
  • Hematocrit or hemoglobin screening
  • Obesity screening and Weight management counseling
  • Iron supplements
  • Fluoride supplements
  • Lead screening
  • Dyslipidemia screening
  • Tuberculin testing
Adolescent health screenings
  • Depression screening
  • Alcohol and drug use assessment
  • Counseling to prevent sexually transmitted infections (STIs)
  • Cervical dysplasia screening
  • HIV screening