NY030658_HIX_INS_MLT Internal Approved 07142015 ©WellCare 2015 NY_07_15 NY5HIXLAN68405M_0715 68405 12 Pts
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.
If you speak a different language or need something in Braille or audio, don’t worry. We can provide translations and alternate formats at no cost to you. Just give us a call toll-free at 1-855-582-6172 (TTY 1-855-582-6171).
Si usted habla un idioma diferente o necesita algo en Braille o audio, no se preocupe. Nosotros podemos proporcionarle traducciones y formatos alternativos sin costo para usted. Simplemente, llámenos sin cargo al 1-855-582-6172 (TTY 1-855-582-6171).
BHP_00371E Internal Approved 07052017
©WellCare 2017
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.
NY7BHPBRO00371E_0000
PREVENTIVE CARE SERVICES COVERED FOR ADULTS
• �Abdominal Aortic Aneurysm screening • Skin cancer behavioral counseling�
(one-time screening for men of certain ages who (for adults age 24)�
have ever smoked)� • �Statin preventive medication (for ages 40–75
• �Alcohol misuse screening and counseling at increased risk but with no history of cardiovascular disease)�
• �Aspirin (for adults of certain ages with certain
cardiovascular risk factors) • Syphilis screening (for adults at higher risk)�
• �Blood pressure screening • Tobacco use counseling and interventions (nonpregnant adults)�
• �Cholesterol screening (for adults of certain ages
or at higher risk) • Tuberculosis screening (for adults at higher risk)
• �Colorectal cancer screening (for adults ages • Type 2 diabetes screening (for adults with high
50–75*) blood pressure)
• �Depression screening • Vitamin D supplements for the prevention of falls (for adults age 65*)
• �Diet counseling (for adults with risk factors for
cardiovascular and diet-related chronic disease)
Immunizations for Adults
• �Exercise or physical therapy for the prevention (Doses, recommended ages and recommended of falls (for adults age 65* at risk) populations vary)�
• �Hepatitis B screening (for adults at higher risk) • Diphtheria, pertussis, tetanus (DPT)
• �Hepatitis C screening (for adults at higher risk) • Hepatitis A and B
• �Herpes zoster
• �HIV screening (for adults at higher risk)
• �Human Papillomavirus (HPV)
• �Lung cancer screening (for adults ages 55–80*�
at risk) • Flu shot�
• �Measles, mumps, rubella (MMR)
• �Obesity screening and counseling
• �Meningitis
• �Sexually Transmitted Infections (STI) prevention
counseling (for adults at higher risk) • 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 • Certain contraceptive methods and counseling (for women with family members with breast, • Domestic and interpersonal violence screening ovarian, tubal or peritoneal cancer) and counseling
• �Breast cancer mammography screening every 1 to • Folic acid supplements (for women of child- 2 years for women age 40 and older* bearing ages)
• �Breast cancer chemoprevention counseling • Gonorrhea screening (for all women at higher risk) (for women at higher risk) • �HIV screening and counseling (for all women at
• �Breast cancer preventive medications (for women increased risk)
at higher risk) • �HPV-DNA test (every 3 years for women with
• �Cervical cancer screening with cytology (Pap normal cytology results who are ages 30 and smear) every 3 years for women ages 21–65*; for older*)
women who want to lengthen the screening • �Osteoporosis screening (for women ages 65* or interval, screening with a combination of cytology younger if at increased risk)
and human papillomavirus (HPV) testing every
• �Sexually Transmitted Infections counseling 5 years
(annually for sexually active women)
• �Chlamydia infection screening (for all women up
• �Well-woman visits (annually for adult women) to age 24 or older* who are at increased risk)
Additional Services Covered for Pregnant Women:
• �Anemia screening on a routine basis • Rh incompatibility screening (for all pregnant women) and follow-up testing for women at
• �Bacteriuria, urinary tract or other infection
higher risk screenings
• �Screening for preeclampsia in pregnant
• �Breastfeeding counseling and support, and access
women, with blood pressure measurements to supplies
throughout pregnancy
• �Gestational diabetes screening (for women 24
• �Syphilis screening to 28 weeks pregnant and those at high risk of
gestational diabetes) • Tobacco use (expanded counseling for pregnant tobacco users)
• �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
*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.
