YNHHS medical plan benefits place a strong emphasis on keeping you and your family healthy and also providing confidential care management and health coaching services if you need to reduce health risk factors or more effectively manage a chronic health condition.

One important way to stay healthy and to identify any potential health problems is to obtain preventive screenings and exams that are appropriate for your age and gender. Preventive care services (italicized in the Medical Plan Benefit Comparison Charts) are generally covered at 100% under the medical plans if you receive them at a YNHHS facility/provider or from an Anthem in-network provider.

It’s important to note that the list of preventive care services covered at 100% is determined by the Affordable Care Act (ACA). The office visit for preventive exams is covered at 100%, as are standard lab tests stipulated by the ACA. However, if your doctor orders additional lab tests or performs additional procedures during a preventive exam that are not stipulated by the ACA, you may be required to pay the copay or deductible and coinsurance for these additional services. An example of when you will have additional cost share is the following:

• When you have an annual physical exam, the office visit and basic lab tests are covered at 100%. However, if your doctor orders tests that are not included under the preventive care portion of the ACA, such as special blood tests to check conditions like gout (uric acid test), the copay or deductible and coinsurance will apply for these additional blood tests.

It’s important to discuss any blood tests that your doctor may be recommending as part of your annual physical exam before you have them. For coverage questions, contact Anthem Customer Service at 1-888-266-2896.

Low to Moderate Dose Statins

In order to comply with United States Preventive Services Task Force (USPSTF), CVS Caremark will add low to moderate dose statins to their standard coverage recommendation for ACA preventive services. The CVS Caremark recommendation for statin coverage includes:

• Men and women ages 40 through 75 years old
• No quantity limit
• No prior authorization
• Low to moderate dose statins, generics only
  (no high dose or brand statins are included)
  • Atorvastatin 10 mg, 20 mg
  • Fluvastatin 20 mg, 40 mg
  • Fluvastatin ER 80 mg
  • Lovastatin 10 mg, 20 mg, 40 mg
  • Pravastatin 10 mg, 20 mg, 40 mg, 80 mg
  • Rosuvastatin 5 mg, 10 mg
  • Simvastatin 5 mg, 10 mg, 20 mg, 40 mg