4 Preventive and Wellness Benefits Preventive/Wellness Plan Pays In - Network Plan Pays Out - of - Network The following “PREVENTIVE/WELLNESS” services are covered by the Plan Routine Examinations Annual physician exam, annual gynecologic exam; routine well child visits 100% Not covered Routine Immunizations Physicians recommended immunizations, annual flu shot (excludes travel vaccines) 100% Not covered Routine Lab and X - ray Ordered or performed in conjunction with routine exam, including annual pap & PSA 100% Not covered Routine Colonoscopy Covered once every three (3) years fro m age 50; or if high risk of colon cancer, per doctor, covered every two (2) years 100% Not covered Routine Mammography One (1) baseline mammogram age 35 - 39 One (1) mammogram per year from age 40 100% Not covered