Guard Your Health and Your Wealth
Save on future medical costs by making healthy choices today. Start Health reimburses certain preventive care services before you meet your deductible.
Your plan covers a fixed amount based on the type of care you receive, regardless of your provider’s charges. If your provider charges more than our benefit amount, you’ll still be responsible for leftover expenses. If your provider charges less, you enjoy the savings.
Important Note: Your benefits depend on whether your visit is billed as routine or diagnostic. Routine (preventive) care means you don’t have symptoms or a diagnosed condition, and only services on the Preventive Schedule are covered by Start 100% at our fixed rates. If your doctor orders extra tests, those may go toward your deductible or not be covered. Diagnostic care is when you have symptoms or a medical condition, and tests are done to find, monitor, or treat and is usually applied to your deductible.
What’s Covered as Preventive Care?
The following procedures and tests may be considered preventive and may be eligible to be reimbursed at the associated Start Health Reimbursement Amount even before your deductible is met.
Wellness Visits:
- Annual Physical Exams & Visits: Regular checkups to keep you healthy.
- Newborn Checkups: Includes visits at 2 weeks, 4 weeks, 8 weeks, and 3 months of age and annual check-ups after that.
- OBGYN Visits: Yearly screenings for women’s health including Pap Smears & Lab Tests
Cancer Screenings:
- Lung Cancer Screening: Available if you meet certain qualifications. Call our Care Coordinators for more information.
- Mammograms: Government guidelines recommend screening for breast cancer once every two years for women over the age of 40. Start Health will reimburse for mammograms according to the recommended limit set by USPSTF
- Preventative Colonoscopy including polyp removal if necessary (See USPSTF Limits)
- Preventative Prostate Exam (See USPSTF Limits)
- PSA (Prostate-Specific Antigen): A blood test for prostate cancer.
Blood Tests:
- Metabolic Panels: Tests for overall health and organ function.
- CBC (Complete Blood Count): A general test to check for conditions like anemia.
Diabetes Screening:
- Yearly testing for diabetes.
- Hemoglobin A1C
Birth Control:
- IUD, ring, and pill forms
Immunizations (Vaccines):
- COVID-19 Vaccines
- Flu Vaccines
- Hepatitis A and Hepatitis B Vaccines
- General Immunizations:
- Shingles
- Tetanus
- HPV (Human Papillomavirus)
- Pneumococcal
- Polio
- Measles
- If billed as preventive:
- Meningococcal vaccines
- Rabies (human diploid-cell vaccine)
- Yellow fever
Other Covered Services:
- Routine vision and hearing screenings for kids
- Behavioral screenings for children 18 and under
Have questions about preventive procedures? Contact our Member Support team for help finding quality, affordable care by calling or texting: (800) 894-9454
Get Added Peace of Mind with Start Shield
Your Start Health base policy already provides comprehensive coverage on a fixed reimbursement schedule-typically 110-145% of Medicare rates. Once your deductible is met, Start Health covers 100% of eligible medical expenses up to our fixed reimbursement schedule. If your provider charges more than the reimbursement rate, you're responsible for the difference.
Start Shield helps when your provider charges more than your base policy covers, after the base policy's deductible has been met. It pays 80% of the extra costs above your base policy's reimbursement, until you reach your Max Out-of-Pocket:
- $8,000 for individuals
- $16,000 for families
Once you hit that limit, Start Shield covers 100% of any remaining costs beyond what your base policy pays. Start Shield only applies to in-network procedures and only after the base policy's deductible has been met. All emergency care is treated as in-network.
