Knowing what your health plan may cover helps you get the care you need while managing your costs. This overview highlights the types of medical services that are commonly included in many health plans. Your specific coverage details can be found on JoinHealth in your plan materials, including your Summary Plan Description (SPD).

🩺 Commonly Covered Services
Most health plans include coverage for a wide range of healthcare services. Below are some examples—but remember, your plan may differ. Always check your Summary Plan Description (SPD) on JoinHealth or contact customer service for the most accurate information.

• Preventive Care
  Routine checkups, immunizations, and screenings designed to help you stay healthy
• Primary and Specialist Visits
  Office visits for common illnesses, chronic conditions, or specialized care
• Hospital and Emergency Services
  Inpatient hospital stays, emergency room visits, and urgent care
• Surgical Procedures
  Medically necessary surgeries, including anesthesia and follow-up care
• Diagnostic Testing
  Lab work, x-rays, MRIs, and other diagnostic imaging services
• Mental Health Services
  Therapy, counseling, and other behavioral health support
• Prescription Medications
  Covered medications to help treat and manage various conditions

🛈 Coverage may require pre-certification, and some services may only be covered when provided by in-network providers.

📄 How to Find What’s Covered in Your Medical Plan
Your Summary Plan Description (SPD) includes all the details about your health plan coverage. To review your benefits on JoinHealth:

1. Click the blue link under the Plan Documents section
2. Review the Schedule of Benefits, Plan Details, and Covered Services sections
3. Look for any requirements, such as pre-certification for certain services

Still have questions? You can reach our customer service team anytime by clicking “Coverage Question” on your home page or calling the number on the back of your member ID card.

💊 How to Find What’s Covered Under Your Prescription Plan
Your health plan includes prescription coverage, but it is managed by a partner known as a Pharmacy Benefit Manager (PBM). They handle your drug list (formulary), costs, and pharmacy network.

To find details about your prescription coverage on JoinHealth:

1. Click the blue link under the Prescription Benefits section
2. Follow the instructions to create or access your PBM account

Or, call the Rx Customer Service number listed on the back of your member ID card.

Important Reminder

This article is for general educational purposes only and does not constitute medical, legal, financial, or benefits advice. Please consult your doctor if you have any questions related to your medical care or treatment.  Actual benefits, coverage details, and out-of-pocket costs may vary by plan. Always refer to your Summary Plan Description (SPD) or contact your plan administrator for specific information about your coverage.