Covered Preventive Care Services

Health New England covers the following preventive care services at no cost to our members when they seek care from in-network providers. Some of these services are also covered as part of routine physical exams, well visits and annual gynecological exams. For a comprehensive listing of Health New England covered preventive care services:

Member Resources

We are proud to be your neighbors! You get your coverage here, your claims paid here, and your questions answered here – by members of your own community. We’ll help you really understand your plan and get the most out of your benefits.

Health New England offers a network of high-caliber physicians, hospitals, medical centers and specialists throughout Western and Central Massachusetts, and in parts of Connecticut. Whether you are getting a routine checkup, filling a prescription, or in need of emergency services – at Health New England, we make it easy for you to get the quality care you are looking for.

We are also committed to keeping health care information simple and easy to access. If you are looking for Medical Policies or other resources, you'll find them here.

Balance Billing by Out-of-Plan Providers: Effective January 1, 2022

The federal “No Surprises Act” creates a process that providers must follow in order to balance bill. Balance billing is when the provider bills for the difference between the provider’s charge and the allowed amount. The allowed amount is the maximum amount on which payment is based for covered services.

This process is the “notice and consent” process. An Out-of-Plan provider must notify a patient of its Out-of-Plan status and get written consent from the patient to receive the Out-of-Plan services. Before obtaining written consent, the provider must first advise the patient of the right not to be balance billed.

The “notice and consent” process is not available for the following:

• Emergency services
• Certain ancillary services (emergency medicine, anesthesiology, pathology, radiology, neonatology, and diagnostic services including radiology and lab services)
• Items and services due to unforeseen urgent medical need during a procedure for which notice and consent has previously been obtained
• Any situation where there is no In-Plan provider available at the In-Plan facility to provide the service

Violations of this balance billing protection can be reported to the Massachusetts Division of Insurance (DOI). You can submit a complaint at this website: https://www.mass.gov/how-to/filing-an-insurance-complaint or you may call (617) 521-7794.

(Does not apply to Medicare or Medicaid.)