Unified Fire Authority
Preventive Care : Zero Out-of-Pocket-Cost
Adult Preventive Services ( ages 18 and older )
Pediatric Preventive Services
( younger than age 18 )
> Rotavirus
> Human Papillomavirus ( HPV ) ( ages 9 to 45 )
Laboratory Tests
> Complete Blood Count ( CBC )
> Prostate Cancer Screening ( PSA )
> Diabetes Screening > Cholesterol Screening > Gonorrhea Screening
> Human Papillomavirus ( HPV ) Testing ( once every 3 years for women ages 30 to 65 )
> Chlamydia Screening
> Human Immunodeficiency Virus ( HIV ) Screening
> Syphilis Screening > Tuberculosis ( TB ) Testing > Lead Screening
> BRCA 1 & 2 Testing ( covered once per lifetime for high-risk individuals who meet criteria )
> Hepatitis B Virus ( HBV ) Screening ( covered for high-risk individuals who meet criteria )
> Hepatitis C Virus ( HCV ) Screening ( once per lifetime for individuals over age 50 )
Procedures
> Pap Test ( once every 275 days for ages 21 and older )
> Lung Cancer Screening ( between ages 50 and 80 )
> Screening Mammogram ( once every 275 days )
> Colonoscopy Colon Cancer Screening ( once every five years for ages 45 to 75 )
> Abdominal Aortic Aneurysm Screening ( males only , once between ages 65 and 75 )
> Bone Density / DEXA ( once every two years in women ages 60 and older )
> Certain Sterilization Procedures ( such as tubal ligation )
Examinations / Counseling > Physical Exam > Eye Exam > Tobacco Use Counseling
> Alcohol Misuse Screening and Counseling
> Annual Hearing Screening ( ages 65 and older )
> Glaucoma Screening ( once every 12 months )
> Sexually Transmitted Infections Counseling
> Dietary Counseling ( 5 visits every 12 months ; only for certain diet-related chronic diseases )
> Depression Screening Immunizations > Influenza
> Tetanus or Tetanus , Diphtheria , and Pertussis ( Td , Tdap )
> Pneumococcal > Hepatitis A & B > Meningitis > Zoster ( ages 18 and older )
> Human Papillomavirus ( HPV ) ( ages 9 to 45 )
Contraception
Most contraceptives are covered as a preventive service under your pharmacy benefits .
> Cervical Cap with Spermicide > Diaphragm with Spermicide
> Emergency Contraception ( Ella , Plan B )
> Female Condom > Implantable Rod > IUDs
> Generic Oral Contraceptives ( Combined Pill , Progestin Only , or Extended / Continuous Use )
> Patch
> Shot / Injection ( Depo-Provera )
> Spermicide > Sponge with Spermicide
> Surgical Sterilization for Women ( Tubal Ligation )
> Surgical Sterilization Implant for Women
> Vaginal Contraceptive Ring
Procedures / Counseling
> Preventive Well-Child Visit ( no limit from birth to age 12 ; every 275 days from ages 12 to 18 )
> Eye Exam > Depression Screening > Developmental Testing
> Newborn Hearing Screening ( once per lifetime )
> Annual Hearing Screening ( ages 21 and younger )
> Application of Fluoride Varnish ( younger than age 5 )
> Dietary Counseling ( 5 visits every 12 months ; only for certain diet-related chronic diseases )
Laboratory Tests
> Newborn Metabolic Screening ( younger than age 1 )
> Human Immunodeficienc Virus ( HIV ) Screening
> PKU Screening ( younger than age 1 )
> Thyroid ( younger than age 1 )
> Sickle Cell Disease Screening ( younger than age 1 )
> Lead Screenings > Tuberculosis ( TB ) Testing Immunizations
( As recommended by the CDC / ACIP )
> Measles , Mumps Rubella ( MMR )
> Diphtheria , Tetanus , Pertussis ( Dtap , DT , DTP )
> Haemophilus Infuenzae Type B ( Hib , DtaP-Hib-IPV , DTP-Hib , Dtap-Hib )
> Polio ( OPV , IPV , DtaP-Hep-LPV )
> Influenza > Pneumococcal > Hepatitis A > Hepatitis B > Meningitis > Varicella ( including MMVR )
Obstetrical Preventive Services
These are specific to pregnant women . To determine which additional non-obstetrical services may be considered preventive , please refer to the Adult or Pediatric Preventive Services lists .
Laboratory Tests
> Iron Deficiency Anemia Screening
> Diabetes Screening
> Urine Study to Detect Asymptomatic Bacteriuria ( first prenatal visit or at 12 to 16 weeks gestation )
> Rubella Screening
> Rh ( D ) Incompatibility Screening
> Hepatitis B Infection Screening ( at first prenatal visit )
> Gonorrhea Screening > Chlamydia Screening > Syphilis Screening
Breast-feeding Supplies and Support
> Breast Pump , Electronic AC or DC ( one per pregnancy )
> Lactation Class ( one per pregnancy at a SelectHealth approved facility )
This information is subject to change at any time and additional limitations may apply . This list may not include all the preventive care available to you for no money out-of-pocket . To verify if your service or supply is considered preventive , call Member Services at 800-538-5038 .
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