Preventive care and early detection are important for your health and well-being. That's why we cover a wide variety of preventive services with no copay and no deductible, meaning no out-of-pocket costs to you.

Check the list below to see which preventive services are covered, for whom and how often they are recommended. (Some grandfathered plans do not cover these services or may cover different services.)

If you have any questions about what preventive care is covered, just contact us.

Preventive medications (including contraceptive products and tobacco cessation products): Information about preventive medications covered under the Affordable Care Act (ACA) is managed by our pharmacy benefits manager, OmedaRx. OmedaRx follows government guidelines to decide which preventive medications we cover. These guidelines are updated periodically to reflect new scientific information and medical advances, so this list and your benefits may change.

If your pharmacy coverage is managed through OmedaRx, sign in to view your prescription benefits information on your Benefits & coverage page.

If your pharmacy coverage isn't managed through OmedaRx, check the guidance of your pharmacy benefits manager.

*Religious exemption: Birth control coverage marked with an asterisk (*) may not be available if the group you have coverage through has a religious exemption.

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
Alcohol misuse 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 Screening for age 18+, including screening held outside of a clinical setting (such as using blood pressure monitoring devices)
Cholesterol (lipid disorders) Screening for age 35+, also ages 20-35 if you are at high risk for heart disease.

Effective November 1, 2017, coverage for all ages. Screening and covered prescriptions and over-the-counter products. See the list of lipid-lowering drugs available at https://www.omedarx.com/preventivemeds
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+
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, ages 10–24
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 A Vaccination, all ages
Hepatitis B Vaccination, all ages
Herpes zoster (shingles) Vaccination, age 60+
Human papillomavirus (HPV, genital warts) Vaccination, up to age 27
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 exams What is covered and when
Annual physical exams Exam for those age 18+
Preventive care service What is covered and when
Alcohol misuse 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+, including screening held outside of a clinical setting (such as using blood pressure monitoring devices)
Breast cancer Mammograms (excludes 3-D) 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), all ages
Breastfeeding—lactation support and counseling Breastfeeding support and counseling when you see a licensed provider, all ages
Breastfeeding supplies Initial breastfeeding supplies that come with a breastfeeding pump, all ages.
Some specialty breastfeeding products will require a prescription and must meet medical necessity.
Cervical cancer (Pap test) Screening if you are sexually active, all ages
Chlamydia (sexually transmitted disease) Screening for all ages
Cholesterol (lipid disorders) Screening for age 35+, also ages 20-35 if you are at high risk for heart disease.

Effective November 1, 2017, coverage for all ages. Screening and covered prescriptions and over-the-counter products. See the list of lipid-lowering drugs available at https://www.omedarx.com/preventivemeds
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+
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 increased risk
HPV (human papillomavirus, genital warts) Screening every 3 years, age 30+
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 10–24
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 A Vaccination, all ages
Hepatitis B Vaccination, all ages
Herpes zoster (shingles) Vaccination, age 60+
Human papillomavirus (HPV, genital warts) Vaccination, up to age 27
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 exams What is covered and when
Annual physical exams Exam for those age 18+
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) when pregnant and after delivery
Breastfeeding—lactation support and counseling Breastfeeding support and counseling with a licensed provider when pregnant and after delivery
Breastfeeding supplies Initial breastfeeding supplies that come with a breastfeeding pump when pregnant and after delivery.
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.
Preventive care service What is covered and when
Anemia (iron deficiency) Screening, up to age 21
Bilirubin screening (newborn jaundice) Screening, newborn
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
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
Fluoride treatment Fluoride treatment by a dentist for children up to age 5, starting when the first tooth appears
Gonorrhea medication (gonorrhea, a sexually transmitted disease, can be passed from mother to baby during birth) Preventive medication for the eyes for newborns
Gonorrhea (sexually transmitted disease/sexually transmitted infection) screening Screening for boys up to 21 and girls of all ages
Hearing One screening for children up to age 1
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 children up to age 2 months
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
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 10–24
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 B Vaccination, all ages
Human papillomavirus (HPV, genital warts) Vaccination, up to age 27
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 exams Wellness exams, up to age 18

 

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.