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Preventive Services, Definitions | Member Services

Preventive Services

Top 3 Things You Should Know

  1. You’re 100% covered. If you see a Network provider, getting defined preventive services are free to you. 
  2. Labs may not be covered. Receiving other services during the same visit as a preventive services visit may be subject to out-of-pocket cost. See our FAQs below for details.
  3. Using preventive services is a good investment! Preventive services help you stay healthy. Plus, studies show that if a majority of people use preventive services, it saves the country billions of dollars.
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List of Definitions

Visit: An appointment with the provider

Service: Often performed during a visit, like an exam, labs, x-ray or counseling

Routine Regularly scheduled. Routine does not necessarily mean preventive.

Preventive services: Exams, tests, or procedures that help keep track of your health and well-being. You receive these services to prevent future health problems. You do no have signs or symptoms. 

Diagnostic Services: Services that evaluate new or established concerns. You have signs or symptoms, or an existing health issue is being monitored. Your deductible, coinsurance and copay might apply.

 

Q:Abdominal Aortic Aneurysm

One-time screening for men ages 65 and older who have ever smoked

Q:Alcohol Misuse

Screening and counseling

Q:Cholesterol

Screening for adults of men over age 35, women over age 45, and other adults ages 20-35 at higher risk

Q:Colorectal Cancer

Screening for adults over age 50

Q:Diabetes Type 2

Screening for asymptomatic adults with sustained high blood pressure

Q:Hepatitis B

Screening in adults at higher risk of infection

Q:Hepatitis C

Screening in adults between the ages of 50 and 60, and those at higher risk of infection

Q:HIV

Screening for all adults at higher risk

Q:Lung Cancer

Screening annually for adults over age 55 with a history of smoking a pack or more of cigarettes a day for at least 30 years

Q:Preventive Office Visit

Such as an annual physical exam, which may include:

  • Aspirin use counseling for men and women of certain ages
  • Assessment and management to prevent falls in adults 65 and older
  • Blood Pressure screening
  • Depression screening
  • Diet counseling for adults at higher risk for chronic disease
  • Counseling for diet and exercise to prevent cardiovascular disease
  • Obesity screening and counseling
  • Counseling for minimizing risks of skin cancer in adults under age 24

Q:Sexually Transmitted Infection (STI)

Prevention counseling for adults at higher risk

Q:Syphilis

Screening for adults at higher risk

Q:Tobacco Use

Screening and interventions for all adults

Q:Vaccines

Recommendations vary for doses, ages, and populations:

  • Hepatitis A
  • Measles, Mumps, Rubella
  • Hepatitis B
  • Meningococcal
  • Herpes Zoster
  • Pneumococcal
  • Human Papillomavirus
  • Tetanus, Diphtheria, Pertussis
  • Influenza
  • Varicella

 

Q:Anemia Screening

On a routine basis during pregnancy

Q:Bacteriuria

Urinary tract or other infection screening in pregnant women

Q:BRCA

Screening and genetic test counseling for women at higher risk for certain cancers

Q:Breast Cancer Mammography

Screenings every 1 to 2 years for women over 40

Q:Breast Cancer Preventive Medication

Counseling about risk-reducing medication for women at higher risk

Q:Breast Feeding

Interventions to support/promote breast feeding, including rental of some breast pumps

Q:Cervical Cancer

Screening

Q:Chlamydia

Screening for sexually active women age 24 and younger and other women at higher risk of infection

Q:Contraceptives

Approved by the FDA and requiring a prescription

Q:Domestic violence

Screening and counseling

Q:Folic Acid Supplements

For women who may become pregnant

Q:Gestational Diabetes

Screening for pregnant women

Q:Gonorrhea

Screening for all women at higher risk of infection

Q:Hepatitis B

Screening at first prenatal visit

Q:HIV

Testing for all pregnant women regardless of risk status

Q:HPV

Testing for women

Q:Osteoporosis

Screening for women 65 and older or women under 65 that meet additional risk criteria

Q:Pre-eclampsia prevention

Counseling on use of aspirin by pregnant women at higher risk

Q:Rh Incompatibility

Screening and follow-up testing for women at higher risk

Q:Syphilis

Screening for all pregnant women regardless of risk status

Q:Tobacco Use

Expanded counseling for pregnant women

Q:Well Woman

Annual visit to obtain women’s preventive services


 

Q:Alcohol and Drug Use

Assessments for adolescents

Q:Autism

Screening for children at 18 and 24 months

Q:Behavioral

Assessments

Q:Cervical Dysplasia

Screening for sexually-active females

Q:Congenital Hypothyroidism

Screening for newborns

Q:Dyslipidemia

Screening for children at higher risk of lipid disorders

Q:Gonorrhea

Preventive medication for the eyes of all newborns

Q:Hearing

Screening for all newborns

Q:Hematocrit or Hemoglobin

Screening

Q:Hemoglobinopathies

Or sickle cell screening for newborns

Q:Hepatitis B

Screening for adolescents at higher risk for infection

Q:HIV

Screening for adolescents at higher risk

Q:Lead

Screening for children at risk of exposure

Q:Newborn Blood Screening

Panel

Q:Preventive Office Visit

Such as a well-child visit, which may include:

  • Blood Pressure screening
  • Depression screening for adolescents at higher risk
  • Developmental screening for children under age 3, and surveillance throughout childhood
  • Recommendation for fluoride chemoprevention supplements for children without fluoride in their water source
  • Height, Weight, and Body Mass Index measurements
  • Recommendation for iron supplements for children ages 6 to 12 months at risk for anemia
  • Medical History
  • Obesity screening and counseling
  • Oral Health risk assessment for young children
  • Vision and hearing screening
  • Counseling on minimizing risks for skin cancer
  • Tobacco use intervention

Q:Sexually Transmitted Infection (STI)

Prevention counseling and screening for adolescents at higher risk

Q:Tuberculin

Testing for children at higher risk of tuberculosis

Q:Vaccines

For children from birth to age 18—recommendations vary for doses, ages, and populations

  • Diphtheria, Tetanus, Pertussis
  • Influenza
  • Measles, Mumps, Rubella
  • Hepatitis A
  • Meningococcal
  • Hepatitis B
  • Pneumococcal
  • Human Papillomavirus
  • Rotavirus
  • Inactivated Poliovirus
  • Varicella
  • Haemophilus Influenzae Type b

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