approval from your plan. This is called a"prior authorization" or "preauthorization." Please contact your PCP or refer 
to the Evidence of Coverage (EOC) for services that require areferral and/or prior authorization from the plan .
2022 - 7 - Summary of Benefits H1036265001 
Covered Medical and Hospital Benefits (cont.)  
Preventive care Our plan covers many preventive services at no cost when you see 
an in-network provider including: 
•Abdominal aortic aneurysm screening