Preventive Services

Under new health care reform legislation, the federal government has released new rules describing which preventive care services will be free to health plan Members. These requirements will be applied to all new Commercial insurance plans issued on or after September 23, 2010.


No Cost Adult Services

The following preventive services will be covered at 100% (i.e., no cost-sharing, no co-pays, no co-insurance) when obtained within participating network:

  • Abdominal Aortic Aneurysm one-time screening for men aged 65 to 75 who have ever smoked
  • Alcohol Misuse screening and counseling
  • Aspirin use for men (aged 45 to 79) and women (aged 55 to 79)
  • Blood Pressure screening for all adults
  • Cholesterol screening for adults of certain ages or at higher risk
  • Colorectal Cancer screening for adults over 50
  • Depression screening for adults
  • Type 2 Diabetes screening for adults with high blood pressure
  • Diet counseling for adults at higher risk for chronic disease
  • HIV screening for all adults at higher risk
  •  Immunization vaccines for adults- (doses, recommended ages, and recommended populations as determined by the CDC):
    • Hepatitis A
    • Hepatitis B
    • Herpes Zoster
    • Human Papillomavirus
    • Influenza
    • Measles, Mumps, Rubella
    • Meningococcal
    • Pneumococcal
    • Tetanus, Diphtheria, Pertussis
    •  Varicella
  • Obesity screening and counseling for all adults
  • Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
  • Tobacco Use screening for all adults and cessation interventions for tobacco users
  • Syphilis screening for adults at higher risk

To obtain a paper copy of the documents listed above, please call the Member Engagement Center at the number listed on your AvMed ID card. (TTY 711 or 1-800-955-8771) Hours of service: 8:00 a.m.-8:00 p.m. Monday through Friday and Saturday from 9:00 a.m. to 1:00 p.m. You may also e-mail your request to members@avmed.org

References:

      1. Healthcare.gov Learning about Prevention.

No Cost Women Services

The following preventive services will be covered at 100% (i.e., no cost-sharing, no co-pays, no co-

insurance) when obtained within participating network:

  • Anemia screening on a routine basis for pregnant women
  • Bacteriuria urinary tract or other infection screening for pregnant women
  • BRCA counseling about genetic testing for women at higher risk
  • Breast Cancer Mammography screenings every one (1) to two (2) years for women over 40
  • Breast Cancer Chemoprevention counseling for women at higher risk
  • Breast Feeding interventions to support and promote breast feeding;
  • Cervical Cancer screening for sexually active women;
  • Chlamydia Infection screening for younger women and other women at higher risk
  • Folic Acid supplements for women who may become pregnant
  • Gonorrhea screening for all women at higher risk
  • Hepatitis B screening for pregnant women at their first prenatal visit
  • Osteoporosis screening for women over age 60 depending on risk factors
  • Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  • Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
  • Syphilis screening for all pregnant women or other women at increased risk

To obtain a paper copy of the document listed above, please call the Member Engagement Center at the number listed on your AvMed ID card. (TTY 711 or 1-800-955-8771). Hours of service: 8:00 a.m. – 8:00 p.m. Monday through Friday and Saturday from 9:00 a.m. to 1:00 p.m. You may also e-mail your request to members@avmed.org

References:

      1. Healthcare.gov Learning about Prevention

 

No Cost Service For Children

The following preventive services will be covered at 100% (i.e., no cost-sharing, no co-pays, no co-insurance) when obtained within participating network:

  • Alcohol and Drug Use assessments for adolescents
  • Autism screening for children age 18 and 24 months
  • Behavioral assessments for children of all ages
  • Cervical Dysplasia screening for sexually active females
  • Congenital Hypothyroidism screening for newborns
  • Developmental screening for children under age three (3), and surveillance throughout childhood
  • Dyslipidemia screening for children at higher risk of lipid disorders
  • Fluoride Chemoprevention supplements for children older than six (6) months without fluoride in their water source
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screening for all newborns
  • Height, Weight and Body Mass Index measurements for children
  • Hematocrit or Hemoglobin screening for children
  • Hemoglobinopathies or sickle cell screening for newborns
  • HIV screening for adolescents at higher risk
  • Immunization vaccines for children from birth to age 18 – (doses, recommended ages, and recommended populations as determined by the CDC):
    • Diphtheria, Tetanus, Pertussis
    • Haemophilus influenzae type b
    • Hepatitis A
    • Hepatitis B
    • Human Papillomavirus
    • Inactivated Poliovirus
    • Influenza
    • Measles, Mumps, Rubella
    • Meningococcal
    • Pneumococcal
    • Rotavirus
    • Varicella
  • Iron supplements for children ages six (6) to 12 months at risk for anemia
  • Lead screening for children at risk of exposure
  • Medical History for all children throughout development
  • Obesity screening and counseling
  • Oral Health risk assessment for young children
  • Phenylketonuria (PKU) screening for this genetic disorder in newborns
  • Sexually Transmitted Infection (STI) prevention counseling for adolescents at higher risk
  • Tuberculin testing for children at higher risk of tuberculosis
  • Vision screening for all children

To obtain a paper copy of the document listed above, please call the Member Engagement Center at the number listed on your AvMed ID card. (TTY 711 or 1-800-955-8771).  Hours of service: 8:00 a.m.- 8:00 p.m. Monday though Friday and Saturday from 9:00 a.m. to 1:00 p.m. You may also e-mail your request to members@avmed.org

References:

1. Healthcare.gov Learning about Prevention.

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