Preventive vs. Diagnostic Care

Preventive vs Diagnostic Care Brochure

One of the most common questions asked to our Member Service Representatives is about the difference between Preventive and Diagnostic services.

Preventive care is given to you when you’re symptom free and have no reason to believe you might be sick. Preventive care includes services such as a routine physical, tests such as a screening mammogram, a screening to see if you have diabetes or immunizations such as a flu shot.

Diagnostic care is what you receive when you have symptoms or risk factors and your doctor wants to diagnose them, or you have a condition that your physician wants to monitor. Diagnostic care includes services such as radiology, ultrasound, or laboratory tests. If you have high cholesterol, diabetes or another medical condition for which you have periodic blood work done, these tests would be considered diagnostic.

Preventive and diagnostic care may occur during the same visit. For example, during a routine check-up your doctor may also discuss a chronic condition you may have and order some tests. The tests your doctor orders may be preventive (such as a screening mammogram) and other tests may be diagnostic (such as a cholesterol check for someone with high cholesterol).

For many preventive services you won’t need to pay anything, while diagnostic services may have a copayment or coinsurance amount that you will need to pay.

Understanding the difference between preventive and diagnostic care will help you understand how your benefits are paid. If you have questions on your benefits or how a service was paid, please contact Member Services at 1-800-852-8300 Monday to Friday 8:00 a.m. to 4:30 p.m.

Download the Brochure

ACA News: Preventive coverage will now include statins

Anthem is updating its ACA preventive care coverage to include generic low-to-moderate dose statins due to the US Preventive Services Task Force recommendation regarding Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. This coverage is effective for December 1, 2017.

Anthem will cover generic low-to-moderate dose statins at 100%, no member cost share for members between the ages of 40-75 years old who have one of the following cardiovascular disease (CVD) risk factors: diabetes, hypertension, dyslipidemia and/or smoking. Risk factors will be identified proactively by pharmacy and medical data.

If a member is not proactively identified, the provider can call or fax Anthem’s Prior Authorization Center if they feel that the member meets the age and risk factor criteria and should receive their generic low-to-moderate dose statin at 100% coverage, no member cost share.

Below is a list of generic low-to-moderate dose statins:

  • Atorvastatin 10 – 20mg
  • Fluvastatin IR and XL 20 – 80mg
  • Lovastatin 10 – 40mg
  • Pravastatin 10 – 80mg
  • Simvastatin 5 – 40mg
  • Rosuvastatin 5 – 10mg

Anthem Data Breach Legal Notice

You may have received in the mail, or via e-mail, a notice regarding a legal settlement reached with Anthem. We have had phone calls inquiring if this notice was authentic or if it was spam mail. The notice is a legitimate one. Anthem reached a settlement in June to resolve a class action lawsuit relating to the 2015 cyber-attack against the company.

For individuals whose information was impacted by the cyber-attack, which was announced by Anthem in February 2015, the settlement provides for an additional two years of credit monitoring and identity protection services. Alternatively, members who already have credit monitoring services may submit a claim to receive alternative compensation for up to $36 instead of credit services.

For more information, visit, or call 1-855-636-6136.

Congratulations to the 2017 Wellness Awards winners!

On Tuesday, April 25, 2017 the Maine Municipal Employees Health Trust’s Wellness Department hosted the 29th annual wellness conference. There were 74 attendees, representing 40 of our member groups. Two groups and one individual were recognized for implementing comprehensive wellness programs at their worksites.

Knox County
Knox County received the Biggest Leap award for offering a wellness program that made the most leaps and bounds. The Knox County wellness committee pushed themselves this past year to consider the health needs of employees and offered programs that have a positive and lasting impact on their health.


City of South Portland
The City of South Portland received the Highest Peak award for taking their wellness program to the next level. The City of South Portland’s wellness committee challenged themselves to involve more employees in the wellness program. They did so by offering incentives and a wide variety of programs to meet the heath interests of individual employees.


Denise Mungen
Denise Mungen, EcoMaine, was honored with the Wellness Champion award for inspiring others to be their healthiest self. She was successful by using her passion, empathy and ability to recognize and overcome barriers to meeting the health needs of employees who work shift work.


A grant from Wellness Works, the health education and promotion program of Maine Municipal Employees Health Trust, provides the necessary funding to help offset the cost of worksite wellness initiatives.  If you would like more information on how to get a wellness program started at your worksite, please contact Anne Charles.

TDES program offers support and savings

Diabetes can be a difficult disease to manage, and there are very serious consequences for those who do not effectively manage it.  Support is available to our members who have diabetes or pre-diabetes, and it comes with a significant financial incentive.

The Telephonic Diabetes Education and Support program (TDES©) features local, individualized education and support from experienced, certified diabetes educators.  It is run by our partners at Medical Care Development Public Health. Participants typically have one in-person visit and monthly follow up phone calls with a diabetes educator to help them stay on track.

While participating in the 12-month program, copays will be waived (paid by the plan) for covered prescribed diabetes medications and diabetes supplies, including testing supplies.  For graduates of the program, a TDES2! plan is available for an additional 12 months.

All adult members with MMEHT medical coverage are eligible to participate, and the program is open to members with diabetes or pre-diabetes.  Effective January 1, 2017 the program is also being offered to retirees on the Medicare Group Companion Plan.

Follow this link for more information or to enroll, or call our Member Service Representatives at 1-800-852-8300.

Home Delivery for convenience and savings

To receive the greatest savings, use mail order for maintenance prescriptions.  Members who fill 90-day prescriptions through the Express Scripts mail order program will continue to save on their copays by paying two co-pays instead of three.  You may still utilize your local pharmacy to fill maintenance prescriptions after January 1, but you will pay three co-pays for a 90-day supply at the pharmacy.

Getting Started with Home Delivery

Check out our new Wellness Works offerings for 2017!

The Health Trust offers a variety of different Health Education classes.  These courses may be arranged for employees during day time or early evening hours.  Please contact your Wellness Coordinator if you are interested in having Wellness Works educators present any of the programs at your worksite. Your Coordinator will then contact us to schedule. Most classes require a minimum of 10 participants.

Health Education Classes 

Wellness Works is the Health Education and Promotion Program of the Maine Municipal Employees Health Trust. Call Us at (800) 452-8786.

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