Preventive Care Services Covered by UMP
You don't have to meet your medical deductible before UMP pays for services covered under the preventive care benefit. When you see a network provider for these services, UMP pays 100% and you don't owe a copayment or coinsurance. If you see a non-network provider, UMP pays the non-network rate (60% of the UMP allowed amount).
Please note that UMP does not cover follow-up visits under the preventive care benefit. When medically necessary, follow-up visits are paid under the medical benefit and are subject to the medical deductible and coinsurance.
Immunizations Covered by UMP
UMP covers all routine immunizations recommended for U.S. residents by the Centers for Disease Control and Prevention (CDC). If you see a network provider, vaccines are covered in full (see list of providers you can see). Otherwise, they are covered at the non-network rate.
Preventive Care Services Covered from Birth to Age 18
| Service Covered | Specific age limits, if any | Frequency |
|---|---|---|
| Routine physical exam | Newborn – 12 months: 7 exams 13-24 months: 3 exams 25-36 months: 2 exams |
|
| Routine physical exam | 3 years-18 years | Once per calendar year |
| Hearing exam, routine | Once per calendar year | |
| Fluoride supplements for children | 6 months - 18 years | |
| HIV screening if at increased risk | 8-18 years | Up to two tests per calendar year |
| Females: Pap smear and screening for chlamydia and gonorrhea | 18 years (younger if sexually active) | No more than once per calendar year (recommended every 1-3 years or as advised by your provider) |
Preventive Care Services for Men and Women Ages 19 and Over
| Service Covered | Specific age limits, if any | Frequency |
|---|---|---|
| Annual physical exam | Once per calendar year | |
| Hearing exam, routine | Once per calendar year | |
| Fasting blood glucose testing for patients diagnosed with high blood pressure or high cholesterol | No more than annually (recommended every 1-3 years) | |
| Cholesterol/lipid screening | Men: 35-65 years Women: 45-65 years For both men and women: After age 65, as recommended by your physician based on risk factors |
Every 5 years |
| Fecal occult blood testing | 50+ years | Once per calendar year |
| Colonoscopy | 50+ years | Once every 10 years, but not within 48 months of screening sigmoidoscopy |
| Flexible sigmoidoscopy | 50+ years | Once every 48 months |
| Barium enema | 50+ years | Once every 5-10 years |
| HIV screening if at increased risk | Age 19 and over | Up to two times per calendar year |
| Services specific to men | Specific age limits, if any | Frequency |
| Abdominal aortic aneurysm ultrasound | 65-75 years | Once per lifetime (for current or prior tobacco users) |
| Services specific to women | Specific age limits, if any | Frequency |
| Pap smear and pelvic exam | 19-64 years (65 years and older as recommended by your provider) | No more than once per calendar year (recommended every 1-3 years or as advised by your provider) |
| Chlamydia and gonorrhea screening | 19-24 years | Once per calendar year |
| Mammogram | 40+ years | Once per calendar year |
| Bone density screening | Beginning at age 65 (or at age 60 as recommended by your provider based on risk factors) | Once every two calendar years |
Only the services listed in the preventive care tables are covered under the preventive care benefit. Additional services aren't covered as preventive care, but may be covered under the medical benefit (subject to the medical deductible and coinsurance), when medically necessary.
UMP covers only one annual physical exam under the preventive care benefit per calendar year. When medically necessary, follow-up visits are covered under the medical benefit and are subject to the annual medical deductible and coinsurance.
