Preventive Care

What is considered a preventive visit?

When you are healthy and not experiencing any symptoms or illness, this would be considered a preventive care visit. It is recommended that all people have a yearly visit, or check-up, with their doctor. At this visit, you will most likely have a physical examination and receive certain screenings and tests. This visit is also a good opportunity to ask your doctor any health questions you may have.

What am I responsible to pay?

Harvard Pilgrim covers preventive care in full¹, as long as you get care with a doctor or provider who is part of our network. This means you pay no copayment, coinsurance, or deductible for preventive care.

Please note: You may receive non-preventive services during a visit that do require a copayment, coinsurance, or deductible. Examples of these services include pregnancy tests, throat cultures, allergy tests, x-rays, ultrasounds, setting of bones and casts, and cardiac stress tests. Please check your specific plan information for additional details.

Preventive screenings, tests, and immunizations

Preventive care is important because certain conditions oftentimes don’t produce any symptoms in their initial stages. But routine screenings can detect potential problems early, when they’re the most treatable. 

Screenings you need depend on your age, gender, family history, and any risk factors you may have. Here are some examples of adult preventive screenings and immunizations your doctor might recommend during a preventive visit:

Preventive screenings

• Blood Pressure
• Breast Cancer 
• Cervical Cancer 
• Cholesterol
• Colorectal Cancer
• Depression
• Diabetes
• Osteoporosis
• Skin Cancer

Preventive immunizations

• COVID
• Hepatitis A
• Hepatitis B
• Human papillomavirus (HPV)
• Influenza
• Meningococcal
• Measles, mumps, rubella
• Pneumococcal
• Tetanus, diphtheria, pertussis
• Zoster

¹ Preventive care may not be eligible for 100% coverage with some plans — please check your specific plan information to confirm. For plans that do provide 100% coverage, preventive care must be received from a provider in the Harvard Pilgrim network. Only certain services qualify as preventive. If you have any questions about whether a service is preventive, please check your specific plan information. Please note: you may receive non-preventive services during a routine visit that require a cost-share. Examples of these services include but are not limited to pregnancy tests, throat cultures, allergy tests, x-rays, ultrasounds, setting of bones and casts, and cardiac stress tests.

² The services listed are covered free of charge, unless you have certain group plans - including self-insured plans and plans that are “grandfathered” under the Affordable Care Act. Check with your employer for the details of your particular plan