Comprehensive Summary of Preventive Services

As part of the Patient Protection and Affordable Health Care Act, the following preventive services for children and adults must be covered at no cost to the member when using in-network providers. These preventive services are covered where clinically appropriate, as recommended by the United States Preventive Services Task Force and supporting evidence. Limitations may apply regarding availability, setting, frequency or method of service/treatment.

The list of services was recently expanded and is effective August 1, 2012.

Service Guidelines
Well child visits (birth to age 21)
  • Autism screenings
  • Certain diagnostic screenings for newborns
  • Developmental screenings for children under age 3
  • Hearing screenings for newborns
  • Hematocrit or hemoglobin screenings
  • HIV screening
  • Lead testing
  • Obesity screening
  • Screening for cervical dysplasia for sexually active females
  • Vision screening
Immunizations
  • Diphtheria, Tetanus, Pertussis
  • Hepatitis A and B
  • Human Papillomavirus
  • Inactivated Polio
  • Influenza and Influenza B
  • Measles, mumps and rubella
  • Meningococcal
  • Pneumococcal
  • Rotavirus
  • Varicella
Preventive prescription drugs
  • Fluoride for preschool age children (P)
  • Iron for children at risk of anemia (OTC*)
Health, diet and weight counseling for qualifying children
Alcohol and drug assessments for older children

(OTC) Over the Counter
(P) Prescription Required
* Requires a prescription from a physician and must be purchased at a pharmacy to obtain the zero-cost share.