Preventive Health Exams vs. Non-Preventive Exams

Health insurance plans that meet the requirements of the Affordable Care Act (ACA) provide no-cost preventive health care visits called Preventive Health Exams (PHE).

Most of Unity’s plans provide PHEs at no copay, even if you have not met your deductible, as long as you go to a health care provider within your network.

If you go to the doctor to get a Preventive Health Exam service at no charge and you discuss a different health problem, you can expect a bill for that additional service. Only PHE services are provided at no out-of-pocket cost.

For example, if you go to the doctor to get your annual physical health exam (a PHE service) and you ask about some other problem, you may be subject to out-of-pocket charges (copay, coinsurance or deductible) for this additional service.

PHE services include annual physical health exams, gynecological exams, child health exams and many immunizations for adults and children. A comprehensive list of no-cost preventive services for adults, women (including pregnant women)
and children is available at unityhealth.com/phe

Call Unity Customer Service

Monday through Friday from 7 a.m. to 7 p.m.

Toll Free: 800.362.3310

Local: 608.644.3430

TDD / TTY: 608.643.1421

Will My Insurance Cover the Bills for the Two Visits?

It is important to know what services are covered by your policy. Please check with Unity prior to your visit. Discuss why you are seeing your health care provider. Ask the following questions –

• What is covered when your office visit is primarily a preventive health care visit?
• What does your policy cover if you are seeing your health care provider about a new or existing health care issue?
• What if you go to the doctor for a preventive health exam and the focus changes to a specific health issue, will your policy cover both portions of the visit?
• What are your out-of-pocket costs for copays, coinsurance or deductibles for each kind of visit?