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Preventative Care

The State believes that preventive care like physical exams and periodic screenings can help detect illness or health risks early, allowing you to take more control of your health. That's why all the PPOs and HMOs the State offers include coverage for preventive care and immunizations.

  • If you enroll in a PPO: The State Employees' PPO and the Health Investor PPO reimburse you for 100% of the allowed amounts for specific preventive care services and immunizations. If you use a non-network provider, preventive care expenses are subject to the deductible and coinsurance, and you are responsible for any amounts above the non-network maximum allowable payment. With the exception of mammograms, the remaining information on this page describes the preventive care and immunization benefits available through the PPOs without a deductible. As a covered benefit, network and non-network costs are associated with mammograms and deductibles do apply.
  • If you enroll in an HMO: Similar preventive care services are covered; check with the specific HMO for more details.

Child Preventive Healthcare and Immunization Benefits - PPO Plans

The PPO plans cover pediatric preventive care and immunizations as mandated by Florida Statutes s.627.6579. You can view the current covered immunizations at www.cispimmunize.org and other covered preventive care at www.aap.org/visit/prevent.htm.

Adult Preventive Care and Immunization Benefits - PPO Plans

Services are covered based on prevailing medical standards and recommendations of the U.S. Preventive Task Force and the American Academy of Family Physicians - for someone who has no symptoms or risk factors. Ages and frequency may vary based on risk factors such as family history.

You can view a complete list of those recommendations at the American Academy of Family Physicians web site under "Clinical & Research." Recommendations for adults include:

Service/Immunization

Male*

Female*

Cholesterol

Age 35, every 5 years

Age 45, every 5 years

Pap Smear

 

Annually

Blood Pressure Check

Age 21 and up, annually

Age 21 and up, annually, as determined by physician

Mammogram *This covered benefit has a cost and is subject to the deductible

 
  • One baseline between ages 35-39
  • One every 2 years, ages 40-49
  • One every year, ages 50 and up
  • Any age and interval as medically necessary

Prostate Specific Antigen (PSA)

Age 50, annually

 

Osteoporosis - bone density test

 

Age 65 and up, as determined by physician

Measles/mumps/rubella (MMR) immunization

 

Age 18-50, once

Colorectal Cancer Screening

  • Fecal occult blood test (FOBT)
  • Double contrast barium enema
  • Flexible sigmoidoscopy
  • Colonoscopy

Age 50, every year or
Age 50, every 5 years

Age 50, every 10 years

Hearing and vision

Annually

Tetanus-Diptheria (TD) immunization

Age 18 and up, every 10 years

Immunization against pneumonia

Age 65 and up, once

Flu shots

Age 50 and up, every year

*Based on asymptomatic and/or zero risk factor patients. Age intervals and frequency may vary based on risk factors such as family history.