The Routine Physical Exam Benefit is for eligible employees, retirees and spouses. It also applies to employees, retirees and spouses who are continuing their coverage by making COBRA self-payments. No benefits are payable under this benefit for dependent children.
This benefit covers charges incurred for routine (preventive) physical examinations and check-ups. If you go to a doctor because you are sick or injured, or because you have symptoms of a sickness or injury, no benefits will be payable under this benefit for that visit. (However, charges for that visit will be considered under the Comprehensive Benefit.)
Covered Expenses; Benefits Payable - Covered expenses under this benefit are the reasonable and customary charges incurred for a doctor's professional routine physical examination. The Plan pays 100% of the covered expenses incurred during a calendar year up to a maximum benefit of $125 per person. There is no deductible. Any covered expenses incurred for routine exams in excess of $125 during a year will not be covered, either under this benefit or under the Comprehensive Benefit.