Healthcare Reform Update - Preventive Care at No Additional Cost

Under the Patient Protection and Affordable Care Act, also known as health care reform, certain preventive care services in many of our plans will be covered with no cost sharing.  This means that you won't be responsible for copayments, coinsurance, or deductible payments for these preventive services if you are enrolled in one of these plans. (Please refer to your Evidence of Coverage to see the cost sharing that applies under your plan.) Below you’ll find a summary of preventive services that must be covered at no charge under health care reform, followed by a list of additional preventive services mandated by the state of California.


NATIONAL PREVENTIVE SERVICES

Preventive services for adults

Exams and discussions
Age-appropriate preventive medical examination
Discussion with primary care physician regarding alcohol misuse
Discussion with primary care physician regarding obesity and weight management
Discussion with primary care physician regarding aspirin for adults at higher risk of cardiovascular disease
Discussion with primary care physician regarding diet counseling for adults at higher risk for chronic disease
Discussion with primary care physician regarding tobacco cessation Screening
Abdominal aortic aneurysm--one-time screening by ultrasonography in men age 65 to 75 who have ever smoked
Blood pressure screening for all adults
Cholesterol screening for adults at higher risk of cardiovascular disease
Colorectal cancer screening for adults age 50 to 75
Prostate cancer screening in men age 50 to 75
Depression screening for adults
Type 2 diabetes screening for adults with high blood pressure   
Screening for all adults at higher risk for sexually transmitted infections and counseling for prevention of sexually transmitted infections, including:
HIV
Gonorrhea
Syphilis
Chlamydia
 
Immunizations

Immunizations for adults (doses, recommended ages, and recommended populations vary):
   Hepatitis A
   Hepatitis B
   Herpes zoster
   Human papillomavirus
   Influenza
   Measles, mumps, rubella
   Meningococcal
   Pneumococcal
   Tetanus, diphtheria, pertussis
   Varicella

Preventive services for women, including pregnant women

Exams and discussions
 Age-appropriate preventive medical examination
 Scheduled prenatal visits and first postpartum visit
 Discussion with primary care physician about interventions to promote and support breast feeding
 Discussion with primary care physician about folic acid supplements for women who may become pregnant
 Discussion with primary care physician regarding chemoprevention in women at higher risk for breast cancer
 Discussion with primary care physician regarding inherited susceptibility to breast and/or ovarian cancer
 Discussion with primary care physician regarding tobacco cessation

Screening
 Mammography screening for breast cancer for women age 50 to 74
 Mammography screening for breast cancer in other age groups as jointly determined by patient and physician
 Cervical cancer screening in women age 21 to 65
 Osteoporosis screening for women age 65 or older and women at higher risk
 Chlamydia infection screening for sexually active women (and men) at higher risk
 Gonorrhea screening for all women at higher risk
 Syphilis screening for all pregnant women and other women at higher risk
 Anemia screening for pregnant women
 Urinary tract or other infection screening for pregnant women
 Hepatitis B screening for pregnant women at their first prenatal visit
 Rh incompatibility screening for pregnant women and follow-up testing for women at higher risk

Preventive services for children

Exams, assessments, and discussions
Age-appropriate preventive medical examination
Medical history for all children throughout development
Height, weight, and body mass index measurements for children
Behavioral assessments for children of all ages by primary care physician
Oral health risk assessment for young children by primary care physician
Discussion with primary care physician regarding alcohol and drug use assessments for adolescents
Discussion with primary care physician regarding obesity screening and counseling
Discussion with primary care physician regarding fluoride supplements for children who have no fluoride in their water source
Discussion with primary care physician regarding iron supplements for children age 6 months to 12 months who are at risk for anemia
Sexually transmitted infection (STI) prevention counseling for adolescents at higher risk

Screening
Developmental screening for children under 3 years and surveillance throughout childhood by primary care physician
Autism screening for children at age 18 months and 24 months by primary care physician
Congenital hypothyroidism screening for newborns
Phenylketonuria (PKU) screening in newborns
Dyslipidemia screening for children at higher risk of lipid disorders
Lead screening for children at risk of exposure
Hearing screening for all newborns
Vision screening for all children
Hematocrit or hemoglobin screening for children
Hemoglobinopathies or sickle cell screening for newborns
Tuberculin testing for children at higher risk of tuberculosis
HIV screening for adolescents at higher risk
Cervical dysplasia screening for sexually active females Immunizations and medication
Gonorrhea prevention medication for the eyes of all newborns
Immunizations for children from birth to 18 years (doses, recommended ages, and recommended populations vary):
Diphtheria, tetanus, pertussis
Haemophilus influenzae type B
Hepatitis A
Hepatitis B
Human papillomavirus
Inactivated poliovirus
Influenza
Measles, mumps, rubella
Meningococcal
Pneumococcal
Rotavirus
Varicella

Additional preventive services in California

We also cover state-mandated services in California that are in addition to those required by federal health care reform. We’ll continue to provide these services as part of our preventive services package for California members.
   Family planning visits*
   Scheduled prenatal visits
   First postpartum visit*
   Health education
   Routine vision examinations
   Routine hearing examinations