Preventative Health

Covered Preventative Benefits

All benefited UND staff and faculty have the following preventative health benefits with 100% coverage. (Note: Co-pay of $25 is required.) Please take advantage of these services for health maintenance and because it might SAVE YOUR LIFE to catch an early diagnosis of cancer or other disease.

Your primary care provider will counsel you as to how often preventative services are needed based on your age, gender and medical status.

Below is an overview of covered preventative benefits. It should not be used solely to determine whether your health care expenses will be paid. The written benefit plan governs the benefits available. If you have any questions, contact our NDPERS representatives at Sanford Health at 1-800-499-3416 to verify coverage.

Immunizations (100% covered)

Hepatitis
MMR (Measled/Mumps/Rubella)
Chicken Pox (Varicella)
DPT (Diptheria/Pertussis/Tetanus)
HPV (Human Papillomavirus) – 100% coverage for males and females ages 9-26
Pneumococcal Disease
Hemophilus Influenza B
Influenza Virus Vaccine – 100% coverage for flu shots and 100% coverage for flu mist for those ages 2-49.
Meningococcal disease
Polio
Zoster Vaccine (shingles) – 100% coverage for ages 50 and older (updated in February 2012).

*Sanford Health follows the coverage recommendations published as policy by the Centers for Disease Control and Prevention.

1 Yearly Physical Exam

100% coverage once each calendar year (January-December).

Mammograms

100% coverage for those who are within the guidelines below:

Females between the ages of 35-39 can have one covered mammogram
Females 40 and older can have one mammogram every year

Pap Smears

Females may receive one pap smear per year with 100% coverage.

PSA (Prostate-Specific Antigen) Test

80% coverage for those who are within the guidelines below:

Once per year for Caucasian males ages 50 and older
Once per year for Black males ages 40 and older
Once per year for males with a family history of prostate cancer ages 40 and older

FOBT (Fecal Occult Blood Testing)

Fecal occult blood testing checks for intestinal conditions and colorectal cancer.

100% coverage for those who are within the guidelines below:

For males and females ages 50 and older

Well Child Care

100% coverage for the following:

Birth through 12 months (7 visits)
13 months through 24 months (3 visits)
25 months through 72 months (1 visit per benefit period)

*Our Sanford Health plan follows recommendations of the American Academy of Pediatrics

Annual $200 benefit for OTHER preventive screenings

Preventative screening is available for members 6 and older up payable at 100% of the allowed charge up to a maximum benefit allowance of $200 per member per benefit period. (Co-pays will apply at the office visit.)

What does that mean?

If I want my cholesterol checked, I first call to determine the cost with the doctor’s office billing department. For my doctor office, it was $102.50. I asked my primary care provider to code this as PREVENTATIVE SCREENING and was able to get it 100% covered (since it was within the $200 allowance). After the $200 preventative maximum has been met (each calendar year), preventative services are paid according to your plan’s cost sharing amount.

You can also apply it to tests such as:

Other cancer screenings
Urinalysis testing
Hemoglobin testing
Blood sugar screening