Preventive Care Benefits
100% covered. Deductible waived. From day one.
Staying ahead of your health shouldn't cost you anything — and with Solo, it doesn't. Preventive care is covered at 100% with the deductible waived, so your annual checkups, screenings, and immunizations come at no cost to you when you see an in-network provider. These benefits are part of your self-funded plan and aligned with the preventive care guidelines under the Affordable Care Act (ACA).
*Out-of-network preventive care may involve extra costs. To keep it at $0, confirm your provider is in-network first. Questions? Contact our support team.
You're covered for the following services at no cost to you when performed by an in-network provider:
Routine Screenings & Exams
- Annual physical exams
- Well-woman visits
- Well-baby and well-child checkups
- Pediatric vision and hearing screenings (age-appropriate)
- Routine gynecological exams and pap tests
- Routine prostate exams and PSA testing
Immunizations (All Ages)
- Flu, pneumonia, and COVID-19
- MMR, HPV, Tdap, Hepatitis A/B, and Varicella
- All CDC-recommended pediatric immunizations more
Screening Tests
- Routine lab tests and diagnostic imaging when part of a preventive visit
- Routine mammograms (1 per year for members 40+)
- Colonoscopies (1 every 10 years for adults 45–75)
Age and frequency follow the federal ACA preventive care guidelines; the SPD governs coverage determinations.
Under Tier 1 of your prescription benefits, approved ACA preventive medications — and certain supplements with a prescription — cost you nothing, even before you've met your deductible. Examples include:
- Statins (for cardiovascular prevention, ages 40–75 with risk factors)
- Aspirin (for preeclampsia prevention in pregnancy)
- Folic acid (for women planning pregnancy)
- HIV PrEP medications
- Fluoride for children
- Smoking cessation aids (nicotine patch, gum, and similar)
The full covered drug list is in the Prescription Drug Formulary, and it's always available in your member portal.
- Stay in-network. Find providers through the Multiplan PHCS (now Claritev) directory to avoid unexpected costs — our network page walks you through the search step by step.
- Bring your ID card. Share your digital or physical ID card at your visit so the office can bill your plan correctly.
- Ask for it to be coded as preventive. Confirm with your provider that your visit and any tests are billed as preventive care. It's a 10-second conversation that ensures full coverage and avoids any surprises.
Preventive means routine and screening-based. Once care becomes diagnostic — investigating a symptom or following up on a finding — it's covered under your regular plan benefits and applies toward your deductible. Not considered preventive:
- Tests ordered outside a routine screening (for example, diagnostic follow-up for a symptom)
- Screenings outside the ACA age and/or gender guidelines
- Non-ACA preventive medications, or brand-name drugs when generics are available
Not sure which side of the line your visit falls on? Ask your provider how it will be coded, or check with Solo Concierge before your appointment.