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Men
Men

Preventive care service

What is covered and when

Abdominal aortic aneurysm (weak area or bulge in the aorta, the body's main artery)

One-time screening for men age 65+ and who have ever smoked

Unhealthy alcohol use

Screening and behavioral counseling for age 18+

Anemia (low iron in your blood)

Screening for up to age 21

Blood glucose, abnormal, and diabetes (type 2)

Screening and behavioral counseling for ages 40–70 if you are overweight or obese

Blood pressure

Age 18+, blood pressure monitor for screening for diagnostic confirmation before starting treatment

Cholesterol (lipid disorders)

Screening and covered prescriptions and over-the counter products, all ages. See the list of lipid lowering agents available at asuris.com/go/ew/rx/forms

Colorectal cancer (colon cancer)

One sigmoidoscopy screening every 5 years, one colonoscopy screening every 10 years and a fecal occult blood test (a test for blood in your stool) every year, and one Cologuard test every 3 years for age 50+ (effective 7/1/19, age 45+)

Depression

Screening during wellness exams for all ages

Diet behavioral counseling

For all ages, counseling about diet changes to help or prevent health problems if you have hyperlipidemia (your blood is high in fats and lipids) and other risk factors

Gonorrhea (sexually transmitted disease/sexually transmitted infection)

Screening for up to age 21

Heart (cardiovascular) disease and prevention

Counseling to promote healthy eating and exercise to prevent heart disease for those age 18+ and overweight or obese

Hepatitis B

Screening for those at high risk, all ages

Hepatitis C

Screening for those at high risk, all ages; one-time screening if you were born between 1945 and 1965 and are not at high risk

HIV

Screening and counseling for ages 15–65, or age 65+ and at high risk

Lead screening (testing for poisoning caused by exposure to lead)

Screening for up to age 21

Lung cancer screening

Annual screening for lung cancer (requires pre-authorization and must meet guidelines for medical necessity) for those age 55–80 who have a smoking history of 30 packs a year and currently smoke or have quit within the last 15 years

Obesity

For age 6+, screening, and counseling if you're diagnosed obese

Prevention of falls

Physical therapy for age 65+, living independently and at high risk for falls

Sexually transmitted disease/sexually transmitted infection (STD/STI)

For all ages, counseling during wellness exams

Skin cancer

Counseling to prevent skin cancer, 6 months up to 24 years for those with fair skin type

Syphilis (sexually transmitted disease/sexually transmitted infection)

All ages

Tobacco use

For all ages, counseling and treatments (but not programs or classes). For covered prescriptions or over-the-counter products, see the Tobacco Cessation Coverage list.

Tuberculosis (TB) screening (a potentially serious disease predominantly affecting the lungs)

For all ages, Tuberculosis skin and lab tests

Vaccinations (shots) (Ask your doctor how often to get these)What is covered and when
Diphtheria, pertussis (whooping cough), tetanus (DPT)Vaccination, all ages
Hepatitis AVaccination, all ages
Hepatitis BVaccination, all ages
Herpes zoster (shingles)Vaccination, age 50+
HPV (Human papillomavirus, genital warts)Vaccination, up to age 45
Influenza (flu)Vaccination, all ages
Measles, mumps, rubella (MMR)Vaccination, all ages
Meningococcal (meningitis)Vaccination, all ages
Pneumococcal (pneumonia)Vaccination, all ages
Varicella (chicken pox)Vaccination, all ages

Prescription drugs

Information regarding our over-the-counter and prescription drug coverage can be found on the PPACA Preventive Medications and Tobacco Cessation Coverage lists.

Wellness examsWhat is covered and when
Annual physical examsExam for those age 18+
Women
Women

Preventive care service

What is covered and when

Unhealthy alcohol use

Screening and behavioral counseling for age 18+

Anemia (low iron in your blood)

Screening for up to age 21

Birth control (contraceptive) education and training

Education and training on birth control methods, all ages

Birth control (contraceptive) methods and devices: cervical caps, IUDs, shots (injectables) and diaphragms

Coverage for all FDA-approved birth control methods, all ages. See the Contraceptives Covered Products list.

Blood glucose, abnormal, and diabetes (type 2)

Screening and behavioral counseling for ages 40–70 if you are overweight or obese

Blood pressure

Screening for age 18+, Blood presssure monitor for screening for diagnostic confirmation before treatment starts

Breast cancer

Mammograms for age 40+ or at high risk

Breast cancer chemoprevention (breast cancer prevention)

Counseling for all ages at high risk

Breastfeeding equipment

Manual and electric breastfeeding pumps that you buy or rent from a licensed provider (but not hospital-grade pumps) within 12 months of baby's birth

Breastfeeding—lactation support and counseling

Breastfeeding support and counseling when you see a licensed provider

Breastfeeding supplies

Initial breastfeeding supplies that come with a breastfeeding pump. Some specialty breastfeeding products will require a prescription and must meet medical necessity.

Cervical cancer (Pap test)

Age 21+

Chlamydia (sexually transmitted disease)

Screening for all ages

Cholesterol (lipid disorders)

Screening and covered prescriptions and over-the counter products, all ages. See the list of lipid lowering agents available at asuris.com/go/ew/rx/forms.

Colorectal cancer (colon cancer)

One sigmoidoscopy screening every 5 years, one colonoscopy screening every 10 years and a fecal occult blood test (a test for blood in your stool) every year, and one Cologuard test every 3 years. Age 50+ (effective 7/1/19, age 45+)

Contraceptives and contraceptive education and training

See "Birth control"

Depression

Screening during wellness exams for all ages

Diet behavior counseling

For all ages, counseling about diet changes to help or prevent health problems if you have hyperlipidemia (your blood is high in fats and lipids) and other risk factors

Genetic risk assessment and BRCA (breast cancer susceptibility) mutation counseling and testing

Risk assessment; also BRCA counseling and testing (requires pre-authorization and must meet guidelines for medical necessity), for all ages if you have a family risk of breast, ovarian, tubal and peritoneal cancer

Gonorrhea (sexually transmitted disease/sexually transmitted infection) screening

Screening for all ages

Heart (cardiovascular) disease and prevention

Counseling to promote healthy eating and exercise to prevent heart disease for those age 18+ and overweight or obese

Hepatitis B

Screening for those at high risk, all ages

Hepatitis C

Screening for those at high risk, all ages; one-time screening if you were born between 1945 and 1965 and are not at high risk

HIV

Screening and counseling for ages 15–65, or age 65+ and at high risk

HPV (human papillomavirus, genital warts)

Screening every 3 years, up to age 45

Interpersonal and domestic violence (physical, sexual or emotional abuse)

Screening and counseling during wellness exams for all ages

Lead screening (testing for poisoning caused by exposure to lead)

Screening for up to age 21

Lung cancer screening

Annual screening for lung cancer (requires pre-authorization and must meet guidelines for medical necessity) for those age 55–80, have a smoking history of 30 packs a year and currently smoke or quit within the last 15 years

Obesity

Screening, and counseling if you're diagnosed obese, age 6+

Osteoporosis (thinning bones)

Screening for age 65+ and all ages if at risk

Prevention of falls

Physical therapy for age 65+, living independently and at high risk for falls

Sexually transmitted disease/sexually transmitted infection (STD/STI)

Counseling during wellness exams, all ages

Skin cancer

Counseling to prevent skin cancer, ages 6 months up to 24 years for those with fair skin type

Sterilization (permanent form of birth control)

For all ages, sterilization

Syphilis (sexually transmitted disease/ sexually transmitted infection)

All ages

Tobacco use

For all ages, counseling and treatments (but not programs or classes). For covered prescriptions or over-the-counter products, see the Tobacco Cessation Coverage list.

Tuberculosis (TB) screening (a potentially serious disease predominantly affecting the lungs)

For all ages, tuberculosis skin and lab tests

Vaccinations (shots) (Ask your doctor how often to get these)What is covered and when
Diphtheria, pertussis (whooping cough), tetanus (DPT) Vaccination, all ages
Hepatitis AVaccination, all ages
Hepatitis BVaccination, all ages
Herpes zoster (shingles)Vaccination, age 50+
HPV (Human papillomavirus, genital warts) Vaccination, up to age 45
Influenza (flu)Vaccination, all ages
Measles, mumps, rubella (MMR) Vaccination, all ages
Meningococcal (meningitis) Vaccination, all ages
Pneumococcal (pneumonia)Vaccination, all ages
Varicella (chicken pox)Vaccination, all ages

Prescription drugs

Information regarding our over-the-counter and prescription drug coverage can be found on the PPACA Preventive Medications, Covered Contraceptive Products and Tobacco Cessation Coverage lists.

Wellness examsWhat is covered and when
Annual physical examsExam for those age 18+
Pregnant women
Pregnant women

Preventive care service

What is covered and when

Anemia (iron deficiency)

Screening when pregnant

Breastfeeding equipment

Manual and electric breastfeeding pumps that you buy or rent from a licensed provider (but not hospital-grade pumps) within 12 months of baby's birth

Breastfeeding—lactation support and counseling

Breastfeeding support and counseling when you see a licensed provider

Breastfeeding supplies

Initial breastfeeding supplies that come with a breastfeeding pump. Some specialty breastfeeding products will require a prescription and must meet medical necessity.

Diabetes—gestational (diabetes that develops during pregnancy)

Screening after 24 weeks of pregnancy and at the first prenatal visit (pregnancy checkup) if at high risk for diabetes

Hepatitis B

Screening when pregnant

HIV

Screening and counseling when pregnant, including if you've never been tested or if you don't know if you have HIV

RH(D) incompatibility (a condition that occurs during pregnancy if you have Rh-negative blood and your baby has Rh-positive blood)

Screening when pregnant

Syphilis (sexually transmitted disease/sexually transmitted infection)

Screening when pregnant

Tobacco use

When pregnant, counseling and treatments (but not programs or classes). For covered prescription and over-the-counter products, see the Tobacco Cessation Coverage list.

Urinary tract infection (bacteriuria)

Screening when pregnant and showing no symptoms

Prescription drugs

Information regarding our over-the-counter and prescription drug coverage can be found on the PPACA Preventive Medications and Tobacco Cessation Coverage lists.

Children (0-17)
Children (0-17)

Preventive care service

What is covered and when

Anemia (iron deficiency)

Screening, up to age 21

Bilirubin screening (newborn jaundice)

Screening, newborn (up to 62 days)

Birth control (contraceptive) education and training

Education and training on birth control methods, all ages

Birth control (contraceptive) methods and devices: implants, cervical caps, IUDs, shots (injectables) and diaphragms

Coverage for all FDA-approved birth control methods, all ages. See the Contraceptives Covered Products list.

Congenital hypothyroidism (a form of thyroid disease)

Screening for newborns (up to 62 days)

Contraceptives and contraceptive education and training

See "Birth control"

Dental (oral) health

Risk assessment for preschool age children

Depression

Screening during wellness exams for all ages

Dyslipidemia (abnormally high cholesterol or fat (triglyceride) in blood)

Screening, up to age 21

Dental caries (cavities) prevention

Fluoride varnish applied by primary care clinicians, up to age 6

Gonorrhea medication (gonorrhea, a sexually transmitted disease, can be passed from mother to baby during birth)

Preventive medication for the eyes for newborns (up to 62 days)

Gonorrhea (sexually transmitted disease/sexually transmitted infection) screening

Screening for boys up to 21 and girls of all ages

Hearing

One screening for newborns (up to 62 days)

Hepatitis B

Screening if at risk for infection, all ages

Hepatitis C

Screening if at risk for infection, all ages

HIV

Screening and counseling for ages 15–18, and those younger who are at risk

Lead screening (testing for poisoning caused by exposure to lead)

Screening, up to age 21

Metabolic screening (the "heel prick test" for rare but serious conditions)

Screening for newborns (up to 62 days)

Obesity

Screening, and counseling if diagnosed obese, age 6+

Phenylketonuria (PKU, a birth defect that causes an amino acid called phenylalanine to build up in the body)

Screening for genetic disorders for newborns (up to 62 days)

Sexually transmitted disease/sexually transmitted infection (STD/STI)

Counseling during wellness exams, all ages

Sickle cell (a serious blood disease)

Screening for children up to age 1

Skin cancer

Counseling to help prevent skin cancer, ages 6 months up to 24 years for those with fair skin type

Syphilis (sexually transmitted disease/sexually transmitted infection)

Screening, for all ages

Tobacco use

For all ages, counseling and treatments (but not programs or classes). For covered prescriptions or over-the-counter products, see the Tobacco Cessation Coverage list.

Tuberculosis (TB) screening (a potentially serious disease predominantly affecting the lungs)

For all ages, Tuberculosis skin and lab tests

Vision (eye exam)

Vision screening for ages 3–5

Immunization vaccinations (shots) (Ask your doctor how often to get these)What is covered and when
Diphtheria, pertussis (whooping cough), tetanus (DPT)Vaccination, all ages
Haemophilus influenzae type b (Hib; a bacterial disease that can cause meningitis)Vaccination, all ages
Hepatitis A Vaccination, all ages
Hepatitis BVaccination, all ages
HPV (Human papillomavirus, genital warts)Vaccination, up to age 45
Inactivated poliovirus (polio)Vaccination, all ages
Influenza (flu)Vaccination, all ages
Measles, mumps, rubella (MMR)Vaccination, all ages
Meningococcal (meningitis)Vaccination, all ages
Pneumococcal (pneumonia)Vaccination, all ages
Rotavirus (severe diarrhea) Vaccination, all ages
Varicella (chicken pox) Vaccination, all ages

Prescription drugs

Information regarding our over-the-counter and prescription drug coverage can be found on the PPACA Preventive Medications, Covered Contraceptive Products and Tobacco Cessation Coverage lists.

Wellness exams What is covered and when
Well-child examsWellness exams, up to age 18

Preventive care brochure

This brochure lists the preventive services covered with your plan.

English version

  • 2020

Spanish version

Birth control coverage

Any contraceptive method approved by the FDA is covered under women's preventive health benefits. This page lists all the birth control drugs and devices you can get at no extra cost with your insurance.

IRS Preventive Care for Chronic Conditions

For members with HSA/HDHP plans, see a list of services that may be covered before you meet your deductible.