A Guide to Getting the Most Out of Your Wellness Coverage

How to Maximize Your Health Insurance Wellness Benefits

Many people overlook the full range of wellness benefits included in their health insurance plan. Preventive care is often covered at 100%, but only if you follow the correct steps. If you don’t, you could end up with unexpected bills. Here’s how to make sure you’re getting the most out of your coverage.

Step 1: Always Use In-Network Providers

If your plan states that wellness services are covered at 100%, that means they are only fully covered when you visit an in-network provider. Before scheduling any preventive care, check your insurance portal or call your provider to confirm that:

✔ Your doctor is in-network.

✔ The facility where you’re receiving care is in-network.

✔ The lab your doctor sends tests to is in-network (yes, you can request a specific lab!).

Example: If your doctor is in-network but they send your Pap smear or blood work to an out-of-network lab, you could end up with an unexpected bill. You have the right to request which lab your samples are sent to—don’t assume they’ll automatically send them to an in-network provider.

Step 2: Understand How Your Wellness Benefits Work

Many preventive screenings are covered under wellness benefits, but only under certain conditions:

• Mammograms & Follow-Ups – Your annual screening is covered, but if they request additional imaging, that is no longer a screening—it’s now a diagnostic test and subject to your deductible.
• Colonoscopies – A screening colonoscopy is covered at 100%. However, if polyps are found and removed, the procedure is classified as a surgery, meaning you’ll owe your deductible and any coinsurance costs.
• Vaccines & Immunizations – Not all pharmacies are in-network, so check before getting shots for yourself or your children.

Step 3: Watch for Billing Mistakes

A common reason wellness benefits don’t get covered is billing errors. If your doctor’s office codes a service incorrectly (e.g., using a diagnostic code instead of a screening code), your insurance may deny coverage. If you receive a bill for a service you thought was fully covered, call your provider and ask if they used the correct billing code.

Step 4: Take Advantage of Extra Wellness Perks

Many insurance plans offer free wellness perks that go unused, including:

✔ Health & Wellness Portals – Many insurers provide rewards (like gift cards) for completing wellness activities. If you have a family plan, make sure each member completes their activities to maximize benefits!

✔ Discounted Gym Memberships – Some plans offer reduced-cost or even free memberships to fitness centers.

✔ Home & Lifestyle Benefits – Certain insurers offer services like free house cleaning, yard work, pet care, or babysitting for a set number of hours per year.

Final Tip: Stay Informed & Use Your Benefits

Your wellness benefits are designed to keep you healthy and save you money, but only if you understand how they work.

📅 Need help navigating your health insurance? Schedule a consultation today at jkappconsulting.com!