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Coverage Guidelines for Common Health Services


Find important information about how common services are covered and where to find specific coverage information in your benefit document. 

Chiropractic Services: Treatment of a disease or condition by manual manipulation of the spine.

Colonoscopy: An outpatient procedure where a long, flexible, lighted scope examines the entire large intestine, from the lowest portion, the rectum, to the lower end of the small intestine.

Durable Medical Equipment (DME): Medical equipment that can stand repeated use and is generally used at home by the patient.

Health Club Reimbursement Program: Fit Choices by MedicaSM is a health club reimbursement program in which Medica provides up to a $20 credit towards health club membership monthly dues when a member visits the facility 8 or more days per calendar month.

Foreign Travel Benefits: Foreign travel benefits will apply when an emergency occurs when the member is out of the United States.

Maternity: Maternity or prenatal includes the comprehensive package of medical and psycho-social services provided throughout the pregnancy. This includes risk assessment, serial surveillance, prenatal education, and use of specialized skills and technology.

MRI (Magnetic Resonance Imaging): A non-invasive method of scanning the body by using electromagnetic waves, which provide visual images on a computer screen and magnetic tape recordings.

Outpatient Surgical Services: Any service where something is inserted into or removed from the body for the treatment of a condition, injury, or illness.

Prescription Benefits: There are many unique ways that prescription benefits are covered. Each plan is different. Different drugs have different coverage levels and some may have specific coverage requirements.

Retractive Eye Exam: A routine eye examination that measures a person’s ability to see an object at a specific distance performed when there is no existing complaint about the patient’s health.

Routine Exams: Routine exams are when there is no existing condition being monitored or no complaint about your health, regardless of the reasons that you scheduled your office visit.