Preventive care list

Preventive care list

Doctor consulting patient

In-network preventive care covered at 100%

Preventive care is care that detects an issue before it becomes a problem. Most Asuris members have 100% coverage for these services. You’ll pay nothing for the care listed here when you see an in-network provider. We follow recommendations from three government agencies to determine which services we cover.

Check the list below to see which preventive services most of our plans cover. Some plans may have limitations or not cover all of these services. Check your plan benefits or call Customer Service at the number on the back of your member ID card if you have questions.

Contraception

Our prescription drug benefit covers all forms of FDA-approved birth control. View the complete list.

Prescription drugs

Your preventive care benefits cover many over-the-counter and prescription drugs. To learn more, visit this page and go to the ACA Preventive Medications, Covered Contraceptive Products and Tobacco Cessation coverage lists.

Why you might see charges

You may have to pay for covered preventive care if:

  • You see an out-of-network provider
  • Your doctor provides preventive care outside the guidelines
  • Your provider doesn’t obtain any required pre-authorization (for example, physical therapy for fall prevention, genetic testing for BRCA 1 and 2 and lung cancer screening)

Preventive vs. diagnostic care

When you go to the doctor, it’s important to know whether the care you get is preventive or diagnostic. Preventive care is precautionary and routine, like an annual physical. Diagnostic care diagnoses or treats new symptoms or existing problems, like additional treatment after a screening detects something abnormal. Sometimes a concern raised during an annual physical can turn into diagnostic care.

Why does this distinction matter? Most in-network preventive care is covered with no out-of-pocket costs—diagnostic will cost money. Ask your doctor for clarification whenever a new test or treatment is ordered.

More information

For more information on preventive services, please visit our FAQ page.

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Members of all ages

Members of all ages

The following services are provided as appropriate to need and age. When an age range is listed, such as 15–18, your coverage includes the first age through the second.

Lab tests

  • Cholesterol screening (if high risk)
  • BRCA 1 and 2 testing and counseling (if high risk and meet criteria)
  • Hepatitis B screening (if high risk)
  • Hepatitis C screening (if high risk or born 1945–1965)
  • HIV screening (15–65 or high risk)
  • Sexually transmitted disease counseling during wellness exams
  • Screening for gonorrhea, syphilis and chlamydia
  • Tuberculosis screening
  • Type 2 diabetes screening and counseling (40–70 if overweight or obese)

Procedures

  • Abdominal aortic aneurysm screening (men only, 65+ and have ever smoked)
  • Cervical cancer screening (Pap) (21+)
  • Colon cancer screening (45+, see regence.com for details and limitations)
  • Lung cancer screening (55–80 with history of smoking)
  • Osteoporosis screening (women 65+ or at risk)
  • Physical therapy to prevent falls (in community-dwelling adults 65+ and at high risk)
  • Screening mammogram (40+ or at high risk)
  • Sterilization (tubal ligation)

Examinations/counseling

  • Annual wellness (physical) exam (18+)
  • Blood pressure monitoring (18+)
  • Breast cancer prevention counseling (if high risk)
  • Depression screening during wellness exams
  • Diabetes counseling (40–70 if overweight or obese)
  • Diet behavior counseling (for those with hyperlipidemia)
  • Heart disease prevention counseling (18+ and overweight or obese)
  • HIV counseling (15–65 or at high risk)
  • HPV screening every three years (30+)
  • Interpersonal and domestic violence screening and counseling during wellness exams
  • Obesity screening and counseling (6+)
  • Sexually transmitted disease counseling during wellness exams
  • Tobacco-use counseling (not programs or classes)
  • Unhealthy alcohol use screening and behavioral counseling (18+)

Immunizations

  • Chicken pox (varicella)
  • Diphtheria, pertussis (whooping cough), tetanus (DPT)
  • Hemophilus influenzae type b (Hib)
  • Hepatitis A and B
  • Herpes zoster (shingles) (50+)
  • HPV (up to 45)
  • Influenza (flu)
  • Measles, mumps, rubella (MMR)
  • Meningitis
  • Pneumonia
Pregnant members

Pregnant members

During pregnancy, members may receive preventive services described under “Members of all ages,” plus the following:

Lab tests

  • Anemia screening
  • Gestational diabetes screening
  • Hepatitis B screening
  • HIV screening and counseling
  • Rh(D) incompatibility screening
  • UTI screening

Breastfeeding/chestfeeding supplies and support

  • Breast pump/lactation pump (non–hospital-grade)
  • Lactation support and counseling
Children

Children

Children may receive age-appropriate preventive services described under “Members of all ages.” When an age range is listed, such as 15–18, your coverage includes the first age through the second. They may also receive the following:

Newborns (up to 62 days of age)

  • Congenital hypothyroidism screening
  • Gonorrhea medication for the eyes
  • Jaundice (bilirubin) screening
  • Metabolic screening
  • PKU screening
  • Sickle cell anemia screening

Youths (up to 21)

  • Anemia screening
  • Dyslipidemia (high cholesterol and fat in blood)
  • Lead poisoning screening

Examinations/counseling

  • Dental caries (up to age 6, starting when first tooth appears)
  • Eye exam (3–5)
  • Fluoride varnish (up to age 6 when applied by primary care clinician)
  • Newborn hearing screening (up to 62 days)
  • Skin cancer counseling (6 months–24 years for those with fair skin type)
  • Well-child exams (up to age 18)

Immunizations

Children may receive age-appropriate immunizations described under “Members of all ages,” plus the following:

  • Polio
  • Rotavirus