Yes — and this is the part of the plan most consistently underestimated, including by people who already own one. Preventive care is built into the schedule rather than bolted on, and it is not a token amount.

What carries a benefit

Each of these has its own line on the schedule, with its own amount and its own annual limit:

  • Annual physical exam
  • Health screening diagnostic labs — up to two tests a year
  • Health screening X-ray
  • Adult flu shot, and child immunisations up to four a year
  • Child allergy treatments — up to ten a year
  • Bone density screening, ages 40 and over
  • Mammogram, women 30 and over
  • Pap smear, women 18 and over, or PSA test, men 40 and over
  • EKG and stress EKG, ages 40 and over
  • Colonoscopy — ages 50 and over as preventive care, or at any age if it is illness related

On the plan level we most often place in North Carolina, the colonoscopy benefit is $750 and the annual physical is $125. Those are not placeholder amounts — for a lot of people they cover the visit outright.

Several of them go up in year two

A genuinely good feature that nobody mentions at the point of sale. Hold the plan through a full calendar year and a number of the screening benefits increase:

The plan you buy improves by keeping it. Worth remembering before you shop it again in eleven months.

The colonoscopy detail worth knowing

Two things here, and they cut in opposite directions.

The good part: the benefit applies from age 50 as preventive care, or at any age if the colonoscopy is illness related. Younger people investigating a symptom are not shut out.

The part to be aware of: for benefit purposes a colonoscopy is treated as wellness, not surgery. It is explicitly excluded from the surgical schedule. So it pays the wellness amount rather than a surgical tier — which is exactly right, but worth knowing if you were expecting the larger number. What does fall under the surgical schedule is set out in does a fixed benefit plan cover surgery.

There is a rider that adds to it

Worth asking about specifically, because it is optional and it is inexpensive relative to what it does.

A wellness rider is available on the critical illness policy, paying $75 per covered wellness exam or procedure, one per calendar year. Covered items include the annual physical, immunisation or vaccination, colonoscopy and mammography. It is subject to a 30-day waiting period, carries an additional premium, and — this is the catch — it is only available at the time of application. It cannot be added later.

Two further riders sit alongside it on the same terms: an outpatient prescription drug rider and a telemedicine rider. All three are add-at-application-only, which is a decent argument for getting the structure right the first time rather than planning to adjust it.

How this compares with preventive care on a marketplace plan

An honest comparison, because it is the question anyone weighing the two will ask. A compliant marketplace plan must cover a defined set of preventive services at no cost share when you use an in-network provider. That is a genuine strength of that design and we are not going to pretend otherwise.

A fixed benefit plan works differently. It pays a stated amount toward each screening rather than covering it in full, which means the arithmetic depends on what your provider charges. For a routine physical or a set of screening labs at ordinary local pricing, the scheduled amount frequently covers the visit outright. For a colonoscopy at a high-cost facility, it may not.

The honest summary is that the marketplace design is more certain on preventive care, and this design is more certain everywhere else — because you know its numbers in advance and there is no deductible standing between you and the first claim. Which matters more depends on whether you qualify for a premium subsidy, and that is the conversation worth having before anything else.

Book the screenings in the right order

A practical point that costs nothing. Several of these benefits are limited to one per calendar year, and the year runs on the calendar rather than on your policy anniversary. A physical in late December and another in early January are two separate benefit years; two in the same autumn are not.

So if you enrol mid-year and you are due a screening, it is generally worth taking it rather than deferring into the new year, because this year's allowance does not carry forward. And if several members of the household are covered, remember the limits are per person — one person using their colonoscopy benefit does not affect anybody else's.

The point people miss

The common worry about a plan like this is that if you stay well, you get nothing for your premium. The wellness schedule is the direct answer to that. A physical, a set of screening labs, a flu shot and an age-appropriate screening in the same year is a real amount of benefit used by somebody who never had a bad day.

So use it. Book the physical. The benefit does not roll over, and a plan whose preventive schedule goes unused every year is a plan being paid for and not used. Whether the plan suits you overall is a separate question, answered in who a fixed benefit plan is right for.

What preventive care does not include here

Stated plainly: routine well-baby care of a newborn while inpatient is excluded except as expressly provided, and eye examinations, eyeglasses, contact lenses, hearing aids and eye refraction are excluded. Dental is excluded except as expressly provided — though accidental injury to natural teeth is payable when treated within six months of the accident, which is narrower than "excluded" suggests.

How The Jordan Insurance Agency helps

We are an independent agency in Charlotte, and our licensed agents have worked with North Carolina families since 2006. We read the wellness schedule out loud on every one of these, because it is the section people skip and the section they are most likely to use.

We will also raise the riders at application, when they are available, rather than after — because after is too late.

Do you mind if we take a look together?

Benefit amounts shown are the carrier's own published figures for the plan design we most often place in North Carolina. There are several plan levels and the amounts differ between them, so we confirm the exact schedule for your plan and state before you apply. This product provides limited benefits. It is a supplement to health insurance and is not a substitute for the minimum essential coverage required by the Affordable Care Act.