Enhanced Choice

Unlimited calendar year maximum

Farm Bureau Health Plans will reimburse 80% of the maximum allowable charge after CYD.

• Broad Formulary. 
• Members may use pharmacy of choice for brand name and/or generic prescriptions; specialty drugs are provided through Optum Specialty Pharmacy.
• Home delivery service is also available.

Pediatric Only

• Services are subject to CYD and coinsurance; quantity and visit limits.
• No calendar year dollar maximum
• Limited orthodontic care
• Included dental benefits utilize UnitedHealthcare's National Options PPO 30 Network.

Members Age 19 and Older

• There is a $40 copay for preventative and restorative services
• Maximum benefit per calendar year is $500 per person
• Included dental benefits utilize UnitedHealthcare's National Options PPO 30 Network.

Pediatric Only - Routine vision benefits including eye exams, eyeglasses and contact lenses

• Eye exams are covered at 100% once every calendar year
• Eyeglass or contact lenses are covered once every calendar year subject to CYD and coinsurance
• Eyeglass frames are covered once every calendar year subject to CYD and coinsurance

Members Age 19 and Above – Benefits are available for routine eye exams, eyeglass or contact lenses

• Eye exams are covered once every calendar year with a limit of $40
• Eyeglass or contact lenses are covered once every calendar year with a limit of $100

1. Preventative health exam for adults and children and related services as outlined below and performed by the physician during the preventative health exam or referred by the physician as appropriate, including:
• Screenings and counseling services with an A or B recommendation by the United States Preventive Services Task Force (USPSTF)
• Bright Futures recommendations for infants, children and adolescents supported by the Health Resources and Services Administration (HRSA)
• Preventative care and screening for women as provided in the guidelines supported by HRSA
• Immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) that have been adopted by the Centers for Disease Control and Prevention (CDC)

1. Annual well woman exam –

• Routine well woman preventative exam office visit
  • Cervical cancer screening
  • Screening mammography at age 40 and older, with one baseline mammogram between the ages of 35 and 39
  • Other USPSTF screenings with an A or B rating 
  • Pap smears 
  • Bone density measurement screening

1. Colorectal cancer screening for members age 45 and older

1. Prostate cancer screening for men age 45 and older

Maternity Benefits available if not a pre-existing condition. If pregnant prior to effective date, six month pre-existing waiting period applies.

Benefits will not be provided for any pre-existing condition until a member has completed a waiting period of at least six months. A pre-existing condition is defined in the contract as “An illness, injury, pregnancy or any other medical condition which existed at any time preceding the effective date of coverage under this contract for which medical advice or treatment was recommended by, or received from, a provider of health care services; or symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment.”

*A copayment will be applied to each office visit for the covered services performed in the office and provided and billed by a physician who is an in-network provider. The remaining charges for covered services rendered during the office visit will be paid at 100% of the maximum allowable charge. If a physician who is an out-of-network provider is utilized for covered services, benefits will be determined on the basis of the out-of-network coinsurance percentage after deductible is met.

Copayments do not apply to the following services: advanced radiological imaging, allergy testing and injections, biopsy interpretation, bone density testing, cardiac diagnostic testing, chemotherapy services, chiropractic services, dental services except preventative and restorative for all Members (and pediatric only), diagnostic services sent out, durable medical equipment, growth hormone injections, IV therapy, Lupron injections, mammography, maternity services, nerve conduction studies, neuropsychological or neurological tests, nuclear cardiology, nuclear medicine, orthotics, preventative services as indicated in contract, prosthetics, provider administered specialty pharmacy products, sleep studies, surgery performed in a physician’s office and related surgical supplies, Synagis injections, therapeutic/rehabilitative/habilitative services, ultrasounds and vision services.

These services are subject to the terms and conditions of the contract and deductibles and coinsurance will apply except where otherwise indicated. Copayments will not be applied toward deductibles or out-of-pocket maximums.