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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


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


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


Screening for adults at higher risk

Q:Tobacco Use

Screening and interventions for all adults


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


Urinary tract or other infection screening in pregnant women


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


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


Screening for all women at higher risk of infection

Q:Hepatitis B

Screening at first prenatal visit


Testing for all pregnant women regardless of risk status


Testing for women


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


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


Screening for children at 18 and 24 months



Q:Cervical Dysplasia

Screening for sexually-active females

Q:Congenital Hypothyroidism

Screening for newborns


Screening for children at higher risk of lipid disorders


Preventive medication for the eyes of all newborns


Screening for all newborns

Q:Hematocrit or Hemoglobin



Or sickle cell screening for newborns

Q:Hepatitis B

Screening for adolescents at higher risk for infection


Screening for adolescents at higher risk


Screening for children at risk of exposure

Q:Newborn Blood Screening


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


Testing for children at higher risk of tuberculosis


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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