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Adult Preventive Services ( ages 18 and older )
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 21-65 )
> 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
> Lung Cancer Screening ( between ages 55 and 80 )
> Screening Mammogram > Colon Cancer Screening
> 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 > Tobacco Use Counseling
> Alcohol Misuse Screening and Counseling
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> Hearing Screening ( ages 65 and older )
> Glaucoma Screening ( Every 12 months )
> Sexually Transmitted Infections Counseling
> Dietary Counseling ( only for certain diet-related chronic diseases )
Immunizations > Influenza
> Tetanus or Tetanus , Diphtheria , and Pertussis ( Td , Tdap )
> Pneumococcal > Hepatitis A > Meningitis
> Zoster ( ages 50 and older OR ages 59 and older )
> Human Papillomavirus ( HPV ) ( ages 9 to 25 )
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
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Pediatric Preventive Services ( younger than age 18 )
Procedures / Counseling
> Well-Child Visit ( preventive when billed on the following schedule : birth ; 2 to 4 days ; 2 to 4 weeks ; 2 , 4 , 6 , 9 , 12 , 15 , and 18 months ; ages 2 , 2 1 / 2 ; once a year from ages 3 to 18 )
> Eye Exam > Developmental Testing
> Newborn Hearing Screening ( once per lifetime )
> Hearing Screening ( ages 10 and younger )
> Application of Fluoride Varnish ( younger than age 5 )
Laboratory Tests
> Newborn Metabolic Screening ( younger than age 1 )
> Human Immunodeficiency Virus ( HIV ) Screening
> PKU Screening ( younger than age 1 )
> Thyroid ( younger than age 1 )
> Sickle Cell Disease Screening ( younger than age 1 )
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
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> Hepatitis B > Meningitis
> Varicella ( including MMVR )
> Rotavirus
> Human Papillomavirus ( HPV ) ( ages 9 to 25 )
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 birth )
> Lactation Class ( one per birth at a SelectHealthapproved facility )
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