Preventive Care

Preventive Care

Preventive care drugs, covered at 100%

Aspirin To prevent cardiovascular events in men and women ages 50-59;
To prevent morbidity and mortality for Preeclampsia in women ages 12-59
Oral Fluoride Applies to children between birth – 5 yrs.
Folic Acid Applies to women under age 50
Iron Supplements Applies to children 6-12 months
Smoking Cessation Applies to ages 18+; limit of 168-day supply of each product in one year of treatment
Vitamin D Applies to men and women age 65+
Bowel Prep Agents (for colonoscopy prep) Applies to all ages
Statins Applies to men and women ages 40-75 for the primary prevention of Cardiovascular disease; generic only, only low to moderate intensity statins

Preventive Screenings

What services are 100% covered?

The following preventive care services are covered at 100% with no deductible, copays or coinsurance, both in- and out-of-network (up to Reasonable & Customary limits):

  • Well child visits for children under age 19, in accordance with USPSTF (United States Preventive Service Task Force) recommendations. Includes Phenylketonuria (PKU) tests
  • Annual physical for adults ages 19 and above, one per calendar year
  • Annual routine gynecological exam for women, one per calendar year. Includes a breast and pelvic examination, treatment of minor infections and PAP test
  • Annual vision screening for adults and children, one per calendar year. Includes refraction
  • Annual hearing screening for adults and children, one per calendar year
  • Diagnostic x-rays and routine laboratory tests
  • Immunizations for children and adults, including travel immunizations
  • Colorectal screenings (100% coverage applies only to the first screening of the calendar year, regardless of diagnosis or place of service). Subsequent preventive screenings covered at 100%; subsequent diagnostic screenings covered at applicable coinsurance level
  • Mammograms (100% coverage applies only to the first mammogram of the calendar year, regardless of diagnosis or place of service). Subsequent preventive screenings covered at 100%; subsequent diagnostic screenings covered at applicable coinsurance level
  • Osteoporosis screening for women
  • PSA blood test and digital rectal exam for men
  • Breastfeeding support , counseling and supplies
  • Purchase/rental of manual or electric breast pumps
  • Annual Cholesterol screening
  • Annual Lung Cancer screening for adults age 55 to 80
  • Chlamydia screening, no age restrictions
  • Genetic counseling, evaluation BRCA1/2 testing for those at risk
  • Annual HIV screening and counseling for sexually active individuals
  • Skin cancer counseling

What are reasonable & customary limits?

Reasonable and customary charges are the fees charged by out-of-network providers for comparable services in the same geographic location, as determined by the plan administrator. The reasonable and customary amount is not necessarily the same as the amount your doctor charges.

* Preventive care guidelines under the Affordable Care Act will change from time to time. And while we try our best to keep this list updated, it may not always reflect the most recent changes. Please check with your medical or prescription drug administrator for the latest preventive care guidelines.