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©WellCare 2017 NY_11_16 NY7CADINS06228E_1200
Essential Plan Preventive Care Services
Staying Healthy Starts with Prevention
WellCare wants to help you live a healthier life. One way we do this is by covering preventive services such as screening tests and shots. These services can help you stay healthy or find issues while they’re easier to treat. You can get them at no cost to you when you use a network provider.
What services are covered?
This brochure lists many of the services you can get. Make sure you visit a network provider when you get them. That way they’ll be covered 100%.
The care you need can vary by your age, gender and health status. Talk to your health care provider to find out which services are right for you.
Preventive care is at the heart of a healthier life.
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What services are NOT covered?
Services that are not considered preventive care include:
• Medical treatment for specific health conditions
• Ongoing care
• Lab or other tests necessary to manage or treat a medical issue or health condition
In some cases, you may have to pay for these services. To get services not listed in this brochure, you may have to pay cost sharing even if your doctor recommends them. (Cost sharing is a fee you pay when you get services. It may be a co-payment, coinsurance or a deductible.)
Where can I find out more about preventive care services?
Call Member Services to learn more about the care your plan covers. You can reach us at the number on the back of your member ID card.
We cover services recommended by the following agencies:
• U.S. Preventive Services Task Force (receiving grades of A or B)
• The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention
• The Health Resources and Services Administration
The list of covered services changes from time to time. Check the current list of federally recommended preventive or wellness care services at www.healthcare.gov.
NOTICE OF NON-DISCRIMINATION
WellCare of New York complies with Federal civil rights laws. WellCare of New York does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
ATTENTION: Language assistance services, free of charge, are available to you. Call 1-855-582-6172. (TTY: 711).
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-855-582-6172. (TTY: 711).
BHP_42292E_PC Internal Approved 08132019
©WellCare 2019
Preventive Care Services Covered for Adults
• Abdominal Aortic Aneurysm screening (one-time screening for men of certain ages who have ever smoked)
• Aspirin (for adults of certain ages with certain cardiovascular risk factors)
• Bacteriuria screening for pregnant women
• Blood pressure screening
• BRCA risk assessment and genetic counseling/testing
• Breast cancer preventive medications
• Breast cancer screening every 1 to 2 years for women age 40 years and older
• Breastfeeding interventions
• Cervical cancer screening
• Chlamydia screening for sexually active women, age 24 or younger and in older women who are at increased risk for infection)
• Colorectal cancer screening (for adults ages 50–75*)
• Dental caries prevention, for infants and children up to age 5 years
• Depression screening for adolescents aged 12 to 18 years, and general adult population, including pregnant and postpartum women
• Diabetes screening, as part of cardiovascular risk assessment in adults age 40 to 70 years, who are overweight or obese
• Falls prevention in community-dwelling adults 65 years or older who are at increased risk for falls
• Folic acid supplementation for all all women who are planning or capable of pregnancy
• Gestational diabetes mellitus screening for pregnant women after 24 weeks of gestation
• Gonorrhea prophylactic medication for newborns
• Gonorrhea screening for sexually active women age 24 years or younger and in older women who are at increased risk for infection
• Healthy diet and physical activity counseling to prevent cardiovascular disease in adults with cardiovascular risk factors
• Hemoglobinopathies screening in newborns
• Hepatitis B screening (for adolescents and adults at higher risk, and pregnant women)
• Hepatitis C screening
• HIV preexposure prophylaxis for the prevention of HIV infection
• HIV screening for adolescents and adults ages 15 to 65 years
• Hypothyroidism screening for newborns
• Intimate partner violence screening for women of reproductive age
• Lung cancer screening (for adults ages 55–80* at risk)
• Obesity screening and counseling
• Osteoporosis screening for women
• Perinatal depression, counseling and interventions
• Phenylketonuria screening in newborns
• Preeclampsia screening and prevention in pregnancy
• Rh incompatibility screening during pregnancy
• Sexually Transmitted Infections (STI) prevention counseling (for adults at higher risk)
• Skin cancer behavioral counseling (for adults age 24)
• Statin preventive medication (for ages 40–75 at increased risk but with no history of cardiovascular disease)
• Syphilis screening (for adults at higher risk and all pregnant women)
• Tobacco use counseling and interventions
• Tuberculosis screening (for adults at higher risk)
Immunizations for Adults
(Doses, recommended ages and recommended populations vary)
• Diphtheria, pertussis, tetanus (DPT)
• Hepatitis A and B
• Herpes zoster
• Human Papillomavirus (HPV)
• Flu shot
• Measles, mumps, rubella (MMR)
• Meningitis
• Pneumonia
• Chicken pox
* Ages are recommendations by the U.S. Preventive Task Force. For the service to be covered, a member must be under 65 at the beginning of the plan year.
Additional Services Covered for Women
• BRCA counseling and genetic counseling/testing (for women with family members with breast, ovarian, tubal or peritoneal cancer)
• Breast cancer mammography screening every 1 to 2 years for women age 40 and older*
• Breast cancer chemoprevention counseling (for women at higher risk)
• Breast cancer preventive medications (for women at higher risk)
• Cervical cancer screening with cytology (Pap smear) every 3 years for women ages 21–65*; for women who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years
• Chlamydia infection screening (for all women up to age 24, or older* who are at increased risk)
• Certain contraceptive methods and counseling
• Domestic and interpersonal violence screening and counseling
• Folic acid supplements (for women of child- bearing ages)
• Gonorrhea screening (for all women at higher risk)
• HIV screening and counseling (for all women at increased risk)
• HPV-DNA test (every 3 years for women with normal cytology results who are ages 30 and older*)
• Osteoporosis screening (for women ages 65*
or younger if at increased risk)
• Sexually Transmitted Infections counseling (annually for sexually active women)
• Well-woman visits (annually for adult women)
Additional Services Covered for Pregnant Women:
• Anemia screening on a routine basis
• Bacteriuria, urinary tract or other infection screenings
• Breastfeeding counseling and support, and access to supplies
• Gestational diabetes screening (for women 24 to 28 weeks pregnant and those at high risk of gestational diabetes)
• Hepatitis B screening (at the first prenatal visit)
• Low-dose aspirin (81 mg/day) as preventive
medication after 12 weeks of gestation for women at risk for preeclampsia
• Rh incompatibility screening (for all pregnant women) and follow-up testing for women at higher risk
• Screening for preeclampsia in pregnant women, with blood pressure measurements throughout pregnancy
• Syphilis screening
• Tobacco use (expanded counseling for pregnant tobacco users)
*Ages are recommendations by the U.S. Preventive Task Force. For the service to be covered, a member must be under 65 at the beginning of the plan year.
