15 / 24
deancare.com
|
15
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 is key information about 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
deancare.com/preventivecare .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 coverage. All Affordable Care Act-compliant health
plans with effective dates in 2014 and 2015 must cover a standard set of health care service categories known as Essential
Health Benefits, with the exception of pediatric oral care. The 10 categories of Essential Health Benefits include:
• 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 to
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 and can be purchased as a
stand-alone product. Please contact your insurance agent or the Marketplace if you wish to purchase pediatric dental coverage or a stand-alone dental
services product.