When you receive eligible Wellness care services from a non-network provider, “Reasonable and Customary” (R&C) limits are applied. If you use in-network providers, you are not responsible for the amount over the contracted rate of any eligible Wellness care expense, even if the provider bills a higher amount. ![]() Anthem Blue Cross negotiates rates with doctors and other healthcare providers to help save you money. To maximize your Wellness Benefit, it is to your advantage to utilize in-network physicians. **If you are in Southern California and you schedule your routine physical exam at one of the UCLA Health/TIHN locations, only $200 will be applied to your annual Wellness Benefit leaving you up to $300 to spend on other eligible services.Īll eligible Wellness care expenses are reimbursed at 100% of either the contracted rate or the allowed amount after Reasonable and Customary (R&C) limits have been applied. ( Note: the Health Fund will not share cost for dietary food supplies or supplements) Weight management – the Health Fund will cover the program fees only, i.e., Weight Watchers, Jenny Craig, and Lindora.Newborn Screening (routine testing for newborns).Routine Prostate Specific Antigen (PSA) test to detect prostate cancer.Anything over the maximum limit will be considered under the medical plan (Age 7+) paid under wellness (up to $500 annual maximum benefit).(Age 0-7) paid under medical, subject to annual deductible and coinsurance.Dyslipidemia Screening – Cholesterol testing (lab work).Breast Cancer (BRCA) Breast Cancer susceptibility gene test.So, what can the Wellness benefit be used for? Here is a partial list of the services it will cover: (The Wellness benefit is not available under the Low Option Plan). Please note: If the Wellness benefit maximum is exhausted, eligible Wellness Care expenses will be considered under the medical plan, subject to the annual deductible, medical necessity review and plan cost sharing requirements. When you or your provider submits a claim to the Health Fund all eligible services will be applied towards your Wellness benefit up to the $500 annual maximum. Using your Wellness benefit is simple just call and make your appointment. Note: For network providers, immunizations and genetic testing are covered under Preventive Care Physical exam to include routine tests and/or immunizations, followed by genetic testing Most common Wellness services utilized in 2015 Number of patients who used all of the Wellness benefit in 2015 Number of patients who used the Wellness benefit in 2015 And yet, while over 20,100 writers (and their dependents) are eligible for the Wellness benefit, less than half that number use any of their Wellness benefits, and an even smaller number use all of their Wellness benefits available to them each year. ![]() You don’t have to first meet the $300 annual deductible before accessing your Wellness Benefits. The Health Plan’s Wellness benefit provides up to $500 to help Participants (and their dependents…up to $1,500 per family) improve their health. “There’s only one restriction… You have to use the money on something to improve your health.” Pretty much anyone would agree to this offer – you would think. Imagine someone said to you, “I’d like to give you five hundred dollars.” “What’s the catch?” you might ask.
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