Even if you’re healthy and feeling good, it’s important to keep up with your preventive care. Periodic health exams, cancer screenings, vaccines and other recommended preventive care services help prevent or detect problems early on when they’re easier to treat. The good news is that, generally, Asuris health plans cover preventive care in full when you see an in-network provider. Some plans may have limitations or may not cover all of these services. Sign in to review your benefits or to find care in your network.
We follow recommendations from three government agencies to determine which services we cover.* When you see an in-network provider, you’ll pay nothing for the preventive services listed here. To easily find providers in your network, sign in and find a doctor.
You may be responsible for an out-of-pocket expense 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
*These scientifically supported guidelines are created by the United States Preventive Services Task Force (USPSTF), Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
Preventive care is precautionary and routine, like an annual physical. Diagnostic care diagnoses or treats new symptoms or existing problems, like additional treatment you receive after a screening detects something abnormal. Let’s say your in-network doctor wants you to get a colonoscopy to screen for colorectal cancer because of your age. This is considered preventive care. However, if your doctor wants you to get a colonoscopy because of symptoms you’re having, then it’s considered diagnostic care.
Why does this distinction matter? Because while in-network, recommended preventive care is covered in full without any out-of-pocket expense to you, diagnostic care may come with costs like copays or deductibles. So, if your doctor recommends a specific test or procedure, be sure to ask if it’s for preventive or diagnostic purposes—that way you’ll know what type of coverage to expect.
Check the list below to see which preventive services most of our plans cover. Some plans may have limitations or may not cover all of these services. If you have any questions, check your benefits or call Customer Service at the number on the back of your member ID card.
Going in for periodic health exams will help you stay on top of your physical health and emotional well-being. Your provider will determine your current health status, identify any risk factors, and discuss which preventive screenings and vaccines are appropriate for you.
Asuris plans cover the following services as appropriate to need and age:
- Annual wellness (physical) exam (for ages 18+)
- Blood pressure monitoring (for ages 18+)
- Breast cancer prevention counseling (for those at high risk)
- Depression screening during wellness exams
- Diabetes counseling (for those ages 40-70 who are overweight or obese)
- Diet behavior counseling (for those with hyperlipidemia)
- Heart disease prevention counseling (for ages 18+ with additional cardiovascular disease (CVD) risk factors)
- HIV counseling (for ages 15-65 or those at high risk)
- HPV screening every three years (for ages 30+)
- Interpersonal and domestic violence screening and counseling during wellness exams
- Obesity screening and counseling in midlife (for those ages 40-60, effective January 1, 2023)
- Obesity screening and counseling (for ages 6+)
- Sexually transmitted disease counseling during wellness exams
- Tobacco-use counseling (not programs or classes)
- Unhealthy alcohol and/or drug use screening and behavioral counseling (for ages 18+)
Your doctor may recommend lab work to check for certain diseases or conditions. To avoid surprise bills, be sure your testing is sent to an in-network lab. To find one in your network, sign in and search for providers; select Medical, then Places by type; and search for “lab.”
Asuris plans cover the following services as appropriate to need and age:
- Cholesterol screening (for those at high risk)
- BRCA 1 and 2 testing and counseling (for those at high risk who meet criteria)
- Hepatitis B screening (for those at increased risk)
- Hepatitis C screening (for those at high risk or ages 18-79)
- HIV screening (for those at high risk or ages 15-65)
- Sexually transmitted disease counseling during wellness exams
- Screening for gonorrhea, syphilis and chlamydia
- Tuberculosis screening
- Prediabetes and type 2 diabetes screening and counseling (35-70 if overweight or obese)
Preventive care includes screening procedures—such as colonoscopies, mammograms and Pap smear tests—that may find cancer early when treatment is likely to work best. These screenings may apply only at certain ages or if you’re at high risk.
Asuris plans cover the following services:
- Abdominal aortic aneurysm screening (men ages 65+ who have ever smoked)
- Cervical cancer screening (Pap) (for ages 21+)
- Colon cancer screening (for ages 45+)
- Lung cancer screening (for ages 50-80 with history of smoking)
- Osteoporosis screening (for women ages 65+ or at risk)
- Physical therapy to prevent falls (in community-dwelling adults ages 65+ and at high risk)
- Screening mammogram (ages 40+ or at high risk)
- Sterilization (tubal ligation)
Routine vaccinations are an important part of staying healthy, for both kids and adults. They protect you and your loved ones, as well as the most vulnerable members of our communities—those too young or sick to be vaccinated. Diseases like measles, polio and whooping cough are rare in developed countries due to vaccination; however, they still pose a threat to people who aren’t vaccinated.
Here are the CDC’s recommended vaccine schedules for children and adults. You can get vaccines at a variety of places: health centers, doctors’ offices, and retail clinics in supermarkets and pharmacies. Make sure they’re in your network so your vaccines are covered.
If you have international travel plans, you’ll need to be up to date on your routine vaccines and check with the CDC for any additional recommended vaccines for your destination. For questions about your travel vaccine coverage, reach out to Customer Service.
Asuris plans cover the following vaccinations:
- Chickenpox (varicella)
- Diphtheria, pertussis (whooping cough), tetanus (DPT)
- Haemophilus influenzae type b (Hib)
- Hepatitis A and B
- Herpes zoster (shingles) (for ages 50+; effective January 1, 2023, age limit will be 19+)
- HPV (up to age 45)
- Influenza (flu)
- Measles, mumps, rubella (MMR)
- Meningitis
- Pneumonia
- Polio (for children)
- Rotavirus (for children)
Your Asuris preventive care benefits cover many over-the-counter and prescription drugs from in-network pharmacies. To learn more, sign in and view the Pharmacy Preventive Medication, Contraceptive Products and Tobacco Cessation Program lists.
Contraceptives
Your prescription drug benefit covers all forms of FDA-approved birth control. To see the list of products covered, sign in and view the Contraceptive Products list. Note: Birth control coverage may not be available if the group you have coverage through has a religious exemption.
People who are pregnant require specific preventive care, like screenings to make sure diseases aren’t transmitted to the baby. During pregnancy, you may receive additional preventive services, including:
Lab tests
- Anemia screening
- Gestational diabetes screening
- Hepatitis B screening
- HIV screening
- Rh(D) incompatibility screening
- Urinary tract infection (UTI) screening
Breastfeeding / chestfeeding supplies and support
- Breast pump/lactation pump (non-hospital-grade)
- Lactation support and counseling
Examinations/counseling
- Counseling to promote healthy weight gain during pregnancy
Even when your child isn’t sick, it’s important for them to see their doctor for regular checkups. Explore our easy-to-read guide on when you should take your child in, as recommended by the American Academy of Pediatrics and the CDC: Schedule of well-child visits and vaccines.
Children may receive age-appropriate preventive services, including:
Examinations/counseling
- Dental cavities (up to age 6, starting when first tooth appears)
- Eye exam (ages 3-5)
- Fluoride varnish (up to age 6 when applied by a primary care clinician)
- Newborn hearing screening (up to 62 days of age)
- Skin cancer counseling (ages 6 months-24 years for those with fair skin type)
- Well-child exams (up to age 18)
Vaccines
- Chickenpox (varicella)
- Diphtheria, pertussis (whooping cough), tetanus (DPT)
- Haemophilus influenzae type b (Hib)
- Hepatitis A and B
- HPV
- Influenza (flu)
- Measles, mumps, rubella (MMR)
- Meningitis
- Pneumonia
- Polio
- Rotavirus
Screenings
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
Children and young adults (up to age 21)
- Anemia screening
- Dyslipidemia (high cholesterol and fat in blood)
- Lead poisoning screening