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Important Preventive Health Services Guidelines


Preventive care is care that focuses on maintaining your health and preventing disease. This includes physical examinations, screenings, and immunizations designed to prevent an illness before you have any symptoms. Please refer to your employer’s plan documents for specific preventive care coverage information.

PREVENTIVE CARE SERVICES FOR ADULTS

Abdominal Aortic Aneurysm Screening Men ages 65 to 75 years who have ever smoked
Alcohol Misuse Screening and Counseling Adults age 18 years or older
Aspirin to prevent cardiovascular disease Men ages 45-79 years Women ages 55-79 years
Blood Pressure Screening Adults age 18 years or older
Cholesterol Screening Men age 35 years and older, or ages 20-35 years if at increased risk Women age 45 years and older, or ages 20 to 45 years if at increased risk
Colorectal Cancer Screening Adults ages 50 and older
Colorectal Cancer Screening Adults ages 50 and older
Depression Screening All adults
Diabetes screening Adults aged 40 to 70 years who are overweight or obese
Falls Prevention Including Physical Therapy and Vitamin D Supplement Adults age 65 years and older in community dwellings
Healthy Diet Counseling Adults at higher risk for diet related chronic diseases
Hepatitis B Screening Adults at high risk for infection
Hepatitis C Screening Adults at high risk and adults born between 1945 and 1965
HIV Screening Adolescents and Adults ages 15 to 65 years and those at increased risk
Immunizations Hepatitis A
Hepatitis B Herpes
Zoster
Human Papillomavirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Tetanus, Diphtheria, Pertussis
Varicella
Lung Cancer Screening Adults age 55-80 who have a 30 pack per year smoking history and who currently smoke or who have quit within the past 15 years
Obesity Screening and Counseling multicomponent behavioral interventions for those with a BMI of 30 kg/m2
Sexually Transmitted Infections Counseling Adults at increased risk
Syphilis Screening Adults at increased risk
Tobacco use Counseling and Interventions Screening for all adults, and behavioral interventions and FDA approved cessation products for adults who use tobacco

ADDITIONAL PREVENTIVE HEALTH SERVICES FOR WOMEN

Anemia Screening Pregnant women
Breast Cancer Mammography Screening Women age 40 and older, every 1-2 years
Breast Cancer Preventive Medication Counseling Women at increased risk for breast cancer
Cervical Cancer Screening Women ages 21 to 65 years
Chlamydia Infection Screening Sexually active women under age 24 and older women at higher risk.
Contraceptive Counseling, Products and Services** Women with reproductive capacity
Folic Acid Supplementation Women who may become pregnant
Genetic Counseling and Evaluation for BRCA Testing Women at increased risk for breast cancer
Gestational Diabetes Screening Women who are 24 to 28 weeks pregnant and those at high risk
Gonorrhea Screening Sexually active women at higher risk
Hepatitis B Screening Pregnant women at their first prenatal visit
HIV Screening and Counseling Counseling and screening for all sexually active women; Screening for all pregnant women, including those who present in labor who are untested and whose HIV status is unknown.
Human Papillomavirus (HPV) Test Women beginning at age 30, no more frequently than every 3 years
Intimate Partner Violence Screening and Counseling All women
Osteoporosis Screening Women over age 65, and younger women at higher risk
Preeclampsia Prevention: Low Dose Aspirin Pregnant women who are at high risk
Rh Incompatibility Screening Pregnant women, (with follow-up testing for women at higher risk)
Sexually Transmitted Infection Counseling All sexually active women, annually
Tobacco Use Screening and Counseling Screening for pregnant women with expanded counseling and behavioral interventions for cessation for pregnant tobacco users.
Syphilis Screening All pregnant women or other women at increased risk
Urinary Tract Infection (Bacteriuria) Screening Pregnant women at 12 to 16 weeks’ gestation or at first prenatal visit, if later.
Well-woman Visits Annually, for women under age 65

PREVENTIVE HEALTH SERVICES FOR CHILDREN

Alcohol & Drug Use Assessments Adolescents
Autism Screening Children ages 18 and 24 months
Behavioral Assessments Children and adolescents at intervals through age 17
Blood Pressure Screening Children and adolescents at intervals through age 17
Cervical Dysplasia Screening Sexually active young women
Congenital Hypothyroidism Screening Newborns
Depression screening Adolescents ages 11-21 years
Developmental Screening Children under age 3 years
Dyslipidemia Screening Children at high risk for lipid disorders at intervals through age 17
Fluoride Supplements Children older than 6 months whose primary water source is deficient in fluoride.
Gonorrhea Preventive Medication Newborns
Hearing Loss Screening Newborns
Height, Weight and BMI measurements Children and adolescents at intervals through age 17
Hematocrit or Hemoglobin Screening Children at age 12 mont
Hemoglobinopathies or Sickle Cell Screening Newborns
HIV Screening Adolescents at increased risk
Hypothyroidism Screening Newborns
Iron Supplementation Children ages 6 to 12 months who are at increased risk of iron deficiency
Immunizations Diphtheria, Tetanus, Pertussis
Haemophilus influenza type B
Hepatitis A
Hepatitis B
Human Papillomavirus
Inactivated Poliovirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Rotavirus
Varicella
Lead Screening Children at risk of exposure to lead
Obesity Screening and Counseling Children ages 6 years and older
Oral Health Risk Assessment Children at intervals through age 10
Phenylketonuria Screening Newborns
Sexually Transmitted Infections Counseling and Screening Sexually active adolescents
Skin Cancer Behavioral Counseling Children/adolescents/young adults ages 10 to 24 years who are at risk
Tobacco Use Interventions School Age Children and Adolescents
Tuberculin Testing Children and adolescents at increased risk at intervals through age 17
Vision Screening Children between the ages of 3 and 5 years, at least once

PLEASE NOTE: These preventive health services guidelines are based on recommendations from the U.S. Preventive Services Task Force (A and B recommendations), the Advisory Committee on Immunization Practices (ACIP) for immunizations, and evidence-informed preventive care and screening guidelines supported by the Health Resources and Services Administration (HRSA) for infants, children, adolescents and for women. This list is not comprehensive, and as new guidelines and recommendations are issued, new services will be required to be covered. Always discuss your particular preventive care needs with your physician. This document provides preventive care coverage highlights. Some services may not be covered under your plan. For specific coverage information refer to the terms or your plan.