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Many generic contraceptives will be covered at no out-of-pocket cost to you on most plans. Because coverage varies by plan, be sure to check your benefits in your online account and use the drug search tool to see if your preferred brand is covered on your specific plan.
Sometimes doctors prescribe birth control for other issues, such as balancing hormones or acne, which would not be covered at 100 percent by your plan. Talk to your doctor about finding the right option for you.
All FDA-approved methods of birth control are covered under most plans, including:
Some employer or group-sponsored plans might not cover contraceptives. Check with your group administrator or benefit booklet for information specific to your plan.
Be sure to take any over-the-counter contraceptives to the pharmacy counter and present your member ID card, so the pharmacist can check your coverage for those products.
Many health plans cover abortion procedures, though some employer-sponsored plans don't. Please check your benefit booklet to confirm.
Plans purchased on Washington Healthplanfinder require that money used for abortion benefits go into a separate fund. This is noted on your statement. No federal funds are used for terminations of pregnancy.
If you are having trouble conceiving, your doctor can do testing to evaluate the issue. Available for men and women, these tests are billed as medical tests and are subject to copay and deductible. Hormone tests and labs are covered if they're not coded for infertility.
Fertility enhancement medications and treatments, such as in-vitro fertilization (IVF) are not covered on most plans. Some employer-sponsored plans do cover it. Check your benefit booklet administrator.
Our plans typically don't cover erectile dysfunction. If you take medication, check Manage Prescriptions to see if it is covered on your plan.
If you've had unprotected sex or want to put your mind at ease, ask your doctor about STD tests. Some STDs don't have symptoms, so getting tested is a good way to protect you and future partners.
There is no single test for all STDs, so talk to your primary care physician about the tests you need. Preventive STD tests, meaning tests done without signs or symptoms of infection, are covered at 100 percent on most health plans. If you are tested because you are exhibiting symptoms, your tests could be billed as diagnostic, which is subject to your plan's copay and deductible. Getting treatment early can prevent risk to you and others.
Certain HIV Preexposure Prophylaxis (PrEP) medication is covered at no cost when used as a preventive measure for those identified as high risk for HIV infection. For additional details, including the effective date of coverage for PrEP at no cost under your health plan, please call customer service.
When a member is 13 or older, explanations of benefits are sent directly to that member, even if he or she is a minor on a parent's plan. This is done in accordance with Washington state law, and means that parents and spouses are unable to see family members’ claims in their online account and unable to discuss sensitive claims with customer service representatives unless the family members gives permission. Members 13 and older must set up their own online member accounts if they want to view their claims and explanation of benefits statements online.
Benefits under your health plan may differ, so refer to your benefit booklet for information on what your specific health plan covers.
Your health plan covers preventive care services as required by state and federal law. For more information, please review the "A" and "B" rated services on the United States Preventive Services Task Force, immunizations recommended by the Centers for Disease Control and Prevention and preventive care and screening recommended by the Health Resources and Services Administration. See the list on healthcare.gov.
