2015 Dean Health Plan Group Plan book

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What is
Covered?
Dean Health Plan strives to provide high-quality health services and valuable benefits in our health plan, just as we
always have. Below are key changes and additions to Dean’s covered benefits.
Preventive Services
The following services are provided with no copays, coinsurance or deductibles when services are delivered by a
network provider, and when all preventive services criteria are met:
• Routine vaccines for both adults and children
• Flu and pneumonia shots
• Preventive care visits for routine screenings and preventive services, including Well Baby and
Well Child visits
• Blood pressure, cholesterol and diabetes screenings
• Colorectal cancer screening for adults over age 50
• Breast cancer mammography screenings every one to two years for women over age 40
For a more comprehensive list, visit
Essential Health Benefits
Essential Health Benefits include common coverage needs, such as visits to the doctor and hospital. They also cover some
services that were previously optional in health plans, including maternity and prescription drug coverage. All small group
plans (2-50 employees) cover Essential Health Benefits. However, if you work for a larger employer (51+ employees) your
benefits may vary. Contact your human resources or benefits department for information about your specific coverage.
The 10 categories of Essential Health Benefits are:
• Ambulatory patient services (outpatient care without being admitted to a hospital)
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
(this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices. This general category includes coverage of a variety of
rehabilitation care, including services such as immediate post-operative, intensive, inpatient hospital rehabilitation
and outpatient rehabilitation therapies provided in a variety of settings. Habilitation services include ongoing,
medically necessary therapies provided to children with developmental disabilities and similar conditions who
need habilitation therapies to achieve functions and skills never before acquired.
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including vision and oral care*
* Dean Health Plan does not offer pediatric dental services. This coverage is available on the Health Insurance Marketplace (healthcare.gov) and can be
purchased as a stand-alone product. Please contact your benefits administrator or the Marketplace if you wish to purchase pediatric dental coverage
or a stand-alone dental services product.