Covered Preventive Care Services

TRS Plans Pay 100% When Using In-Network Providers

Updated September 2022

We encourage you to take full advantage of your health benefits by using your preventive care services. Preventive care refers to routine health check-ups and screenings for common diseases that can help you avoid further health issues and increased costs down the road.

TRS plans will pay 100% of in-network office visits and lab tests for preventive care. Preventive services from an out-of-network provider are subject to any applicable deductible and coinsurance.

Coverage of preventive services and screenings are based off recommendations from the United States Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention (CDC). TRS also considered additional preventive services for infants, children, adolescents and women based off recommendations from the Health Resources and Services Administration (HRSA).

Know the Difference: Preventive vs. Diagnostic

It’s important to know the difference between preventive and diagnostic care. Diagnostic care refers to the diagnosis, treatment and monitoring of a disease or condition. If your visit results in the diagnosis of a condition or treatment of an existing condition, this service is diagnostic.

Preventive Care Service

• You have a screening done within the recommended timeframe (i.e. annual mammogram) with normal findings.
• You have diagnostic service results that were normal and future preventive screenings follow the recommended preventive services timeframe.
• You have a preventive care service done that results in a therapeutic service that your physician requires be done at the same medical visit but does not result in a diagnosis.

Diagnostic Care Service

• You have abnormalities found on a current or previous preventive or diagnostic care service that requires further diagnostic services or a repeat of the same service within a shortened timeframe.
• You have a symptom(s) that required further diagnosis.

Preventive care services may change as USPSTF, CDC and HRSA guidelines are modified.

The chart below shows a list of common covered preventive services. The following list is for quick reference only, is not an exhaustive list, and is based on the more detailed clinical best practice guidelines.

If you have additional questions about what preventive services are covered based on your demographics, please refer to your benefits booklet or contact your health plan.