Bronze Select NS INN Univera PPO Local Adult/Family Dental Dep25 Preventive Rx Acupuncture
78124NY0950013
Expanded Bronze
EPO
Bronze Select NS INN Univera PPO Local Adult/Family Dental Dep25 Preventive Rx Acupuncture is an Expanded Bronze EPO plan by Excellus Health Plan, Inc..
Locations
Bronze Select NS INN Univera PPO Local Adult/Family Dental Dep25 Preventive Rx Acupuncture is offered in the following counties.
Plan Overview
This is a plan overview for 2022 version of Bronze Select NS INN Univera PPO Local Adult/Family Dental Dep25 Preventive Rx Acupuncture 78124NY0950013.
| Insurer: | Excellus Health Plan, Inc. |
| Network Type: | EPO |
| Metal Type: | Expanded Bronze |
| HSA Eligible?: | Yes |
| Plan ID: | 78124NY0950013 |
Cost-Sharing Overview
Bronze Select NS INN Univera PPO Local Adult/Family Dental Dep25 Preventive Rx Acupuncture offers the following cost-sharing.
Cost-Sharing
Out-of-Network Cost-Sharing
Cost-Sharing Examples
Cost-Sharing
Cost-sharing for Bronze Select NS INN Univera PPO Local Adult/Family Dental Dep25 Preventive Rx Acupuncture includes your out-of-pocket maximum, your annual deductible, and coinsurance under this plan.
| Cost Sharing Type | Individual | Family |
|---|---|---|
| Out-of-Pocket Maximum: | 7000 | 7000 per person | $14000 per group |
| Deductible: | 5500 | 7000 per person | $11000 per group |
| Coinsurance: | 7000 per person | $11000 per group | |
Out-of-Network Cost-Sharing
Some plans have different cost-sharing out-of-network. The out-of-network cost-sharing for Bronze Select NS INN Univera PPO Local Adult/Family Dental Dep25 Preventive Rx Acupuncture will be shown below if applicable.
| Cost Sharing Type | Individual | Family |
|---|---|---|
| Out-of-Network Maximum: | 0 | 0 per person | $0 per group |
| Out-of-Network Deductible: | 0 | 0 per person | $0 per group |
Cost-Sharing Examples
The cost-sharing for the sample Summary of Benefits & Coverage (SBC) scenarios of having a baby, having diabetes, and having a simple fracture.
| Deductible: | 5500 |
| Copayment: | 0 |
| Coinsurance: | 1500 |
| Limit: | 60 |
| Deductible: | 1500 |
| Copayment: | 0 |
| Coinsurance: | 0 |
| Limit: | 20 |
| Deductible: | 2800 |
| Copayment: | 0 |
| Coinsurance: | 0 |
| Limit: | 0 |
Notes:
- Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
- You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Bronze Select NS INN Univera PPO Local Adult/Family Dental Dep25 Preventive Rx Acupuncture?
Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904
Plan Features
Bronze Select NS INN Univera PPO Local Adult/Family Dental Dep25 Preventive Rx Acupuncture offers the following features and referral requirements.
| Wellness Program: | No |
| Disease Program: | |
| Notice Pregnancy: | No |
| Referral Specialist: | No |
| Specialist Requiring Referral: | |
| Plan Exclusions: | |
| Child Only Option?: | Allows Adult and Child-Only |
Network Details
The following network details will help you understand what Bronze Select NS INN Univera PPO Local Adult/Family Dental Dep25 Preventive Rx Acupuncture covers when you are out of the service area or out of the country.
| Out of Country Coverage: | Yes |
| Out of Country Coverage Description: | Emergency Services Only |
| Out of Service Area Coverage: | No |
| Out of Service Area Coverage Description: | |
| National Network: | No |
Additional Benefits and Cost-Sharing
Bronze Select NS INN Univera PPO Local Adult/Family Dental Dep25 Preventive Rx Acupuncture includes the following benefits at the cost sharing rates listed below.
| Service | In-Network Copay / Coinsurance | Out-of-Network Copay / Coinsurance | Limits and Explanation |
|---|---|---|---|
| Basic Dental Care – Adult Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 1 Visit(s) per 6 Months Preventive dental coverage for procedures which help prevent oral disease from occurring, including but not limited to, prophylaxis (scaling and polishing teeth at 6-month intervals).Not EHB |
| Second Opinion Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Dental Check-Up for Children Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 1 Visit(s) per 6 Months Additional EHB Benefit |
| Delivery and All Inpatient Services for Maternity Care Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Long-Term/Custodial Nursing Home Care Not Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Sterilization Procedures for Men Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Other Law/Regulation |
| Contact Lenses Not Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Inpatient Physician and Surgical Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Hearing Aids Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Covers a single purchase (including repair and/or replacement) of hearing aids for one or both ears once every three years.Additional EHB Benefit |
| Private-Duty Nursing Not Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Gym Membership Reimbursement Covered | Excluded from In-Network MOOP: Yes | Excluded from Out-of-Network MOOP: Yes | Up to $200 per 6 month period; up to an additional $100 per 6 month period for SpouseAdditional EHB Benefit |
| Dialysis Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Design Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Free preventive care and flu shots, and preventive drugs are not subject to the plan deductible. Telemedicine services covered at no cost after your deductible is met. Plan includes dental and vision exams for you and your family. No referrals needed and no need to identify a Primary Care Physician. Coverage for services in network only with access to 100% of local hospitals and 98% of doctors throughout 39 counties in New York State. Get paid up to $600 for working out with our ExerciseRewards Program and earn $100 by submitting proof of your dental cleaning and exam. Univera members get access to our free tools for Healthy Living including a 24/7 Nurse Call Line and Perks 4 U which offers great discounts on healthy programs and services. This plan has an aggregate deductible and out of pocket maximum.Not EHB |
| Generic Drugs Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Orthodontia – Child Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Eating Disorder Treatment Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Substance Abuse Disorder Outpatient Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Also includes 20 visits per year for family counseling.Additional EHB Benefit |
| Urgent Care Centers or Facilities Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Home Health Care Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 40 Visit(s) per Year Each visit of up to four hours by a home health aide is one visit. |
| Outpatient Rehabilitation Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 60 Visit(s) per Year 60 visits per condition per year combined. Physical and speech therapy are only covered following a hospital stay or surgery.Additional EHB Benefit |
| Breast Reconstructive Surgery Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Not EHB |
| Contact Lenses for Children Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 1 Item(s) per Year One prescribed lenses and frames in a 12-month period.Additional EHB Benefit |
| Cardiac Rehabilitation Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Routine Eye Exam for Children Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 1 Exam(s) per Benefit Period Additional EHB Benefit |
| Other Practitioner Office Visit (Nurse, Physician Assistant) Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Major Dental Care – Child Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Skilled Nursing Facility Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 200 Days per Year |
| Reconstructive Surgery Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Family Planning Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Other Law/Regulation |
| Non-Preferred Brand Drugs Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Frames & Lenses Not Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Inpatient Rehabilitation Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 60 Visit(s) per Year 60 visits per condition per year combined. Physical and speech therapy are only covered following a hospital stay or surgery.Additional EHB Benefit |
| Habilitation Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 60 Visit(s) per Year Services consisting of physical therapy, speech therapy, and occupational therapy, in the outpatient department of a Facility or in a Health Care Professional's office.Additional EHB Benefit |
| Emergency Transportation/Ambulance Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Routine Dental Services (Adult) Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 1 Visit(s) per 6 Months Routine Dental Care (exams, x-rays and fillings), One dental exam and cleaning every 6 months and x-rays (full mouth and panoramic) every 36 months.Not EHB |
| Mental/Behavioral Health Outpatient Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Emergency Room Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Preventive Care/Screening/Immunization Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Prostate Cancer Screening Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Routine Eye Exam (Adult) Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Not EHB |
| Substance Abuse Disorder Inpatient Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Telemedicine Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Members have access to MDLIVEs vast network of Board-Certified doctors for non-emergency care. The system is easy to use, accessible through a toll-free phone number, video conferencing via the Web, or a secure mobile app available for smartphones. MDLIVE does not replace a members physician – rather it is another option to receive care for acute, non-life threatening conditions when a doctor is unavailable or serves as an alternative to urgent care or emergency room visits. Using MDLIVE may result in a lower member cost share. Please consult the subscriber contract for more information.Additional EHB Benefit |
| Applied Behavior Analysis Based Therapies Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Mental/Behavioral Health Inpatient Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Specialty Drugs Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Infusion Therapy Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Any visits for home infusion therapy count towards your home health care visit limit.Additional EHB Benefit |
| Major Dental Care – Adult Not Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| X-rays and Diagnostic Imaging Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Primary Care Visit to Treat an Injury or Illness Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Abortion for Which Public Funding is Prohibited Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 1 Procedure(s) per Year Other Law/Regulation |
| Basic Dental Care – Child Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Prosthetic Devices Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 1 external prosthetic device per limb per lifetime with coverage for repairs and replacements (limit does not apply to internal devices). |
| Acupuncture Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 10 Visit(s) per Year Additional EHB Benefit |
| Treatment for Temporomandibular Joint Disorders Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Covered When Medical In NatureAdditional EHB Benefit |
| Imaging (CT/PET Scans, MRIs) Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Orthodontia – Adult Not Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Chemotherapy Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Nutritional Counseling Not Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Accidental Dental Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Prenatal and Postnatal Care Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Radiation Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Transplant Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Transplants determined to be nonexperimental and non-investigational are covered, including but not limited to: kidney, corneal, liver, heart, and heart/lung transplants; and bone marrow transplants for aplastic anemia, leukemia, severe combined immunodeficiency disease and Wiskott-Aldrich Syndrome.Additional EHB Benefit |
| Rehabilitative Occupational and Rehabilitative Physical Therapy Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 60 Visit(s) per Year 60 visits per condition per year combined. Physical and speech therapy are only covered following a hospital stay or surgery.Additional EHB Benefit |
| Diabetes Education Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Assistive Communication Devices Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Preferred Brand Drugs Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Cochlear Implants Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 1 per ear per time covered.Additional EHB Benefit |
| Inpatient Hospital Services (e.g., Hospital Stay) Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Autologous Blood Banking Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Specialist Visit Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Diabetic Equipment and Supplies Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Durable Medical Equipment Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Hospice Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 210 Days per Year Also includes 5 visits for family bereavement counseling.Additional EHB Benefit |
| Well Baby Visits and Care Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Laboratory Outpatient and Professional Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Preadmission Testing Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Weight Loss Programs Not Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Eye Glasses for Children Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 1 Item(s) per Benefit Period One prescribed lenses and frames in a 12-month period.Additional EHB Benefit |
| Chiropractic Care Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Outpatient Surgery Physician/Surgical Services Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Medical Supplies Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Bariatric Surgery Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Routine Foot Care Not Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Cosmetic Surgery Not Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Infertility Treatment Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | Additional EHB Benefit |
| Allergy Testing Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | |
| Rehabilitative Speech Therapy Covered | Excluded from In-Network MOOP: No | Excluded from Out-of-Network MOOP: No | 60 Visit(s) per Year 60 visits per condition per year combined. Physical and speech therapy are only covered following a hospital stay or surgery.Additional EHB Benefit |
Free Preventive Services
There is no copayment or coinsurance for any of the following Bronze Select NS INN Univera PPO Local Adult/Family Dental Dep25 Preventive Rx Acupuncture preventive services. This is true even if you haven’t met your yearly deductible.
Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.
Preventive Care Benefits for All Adults
Preventive Care Benefits for Women
Preventive Care Benefits for Children
Preventive Care Benefits for All Adults
Preventive care benefits for adults
- Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
- Alcohol misuse screening and counseling
- Aspirin use to prevent cardiovascular disease and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk
- Blood pressure screening
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal cancer screening for adults 45 to 75
- Depression screening
- Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese
- Diet counseling for adults at higher risk for chronic disease
- Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over, living in a community setting
- Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
- Hepatitis C screening for adults age 18 to 79 years
- HIV screening for everyone age 15 to 65, and other ages at increased risk
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adults at high risk for getting HIV through sex or injection drug use
- Immunizations for adults — doses, recommended ages, and recommended populations vary:
- Chickenpox (Varicella)
- Diphtheria
- Flu (influenza)
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Measles
- Meningococcal
- Mumps
- Whooping Cough (Pertussis)
- Pneumococcal
- Rubella
- Shingles
- Tetanus
- Lung cancer screening for adults 50 to 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
- Obesity screening and counseling
- Sexually transmitted infection (STI) prevention counseling for adults at higher risk
- Statin preventive medication for adults 40 to 75 at high risk
- Syphilis screening for adults at higher risk
- Tobacco use screening for all adults and cessation interventions for tobacco users
- Tuberculosis screening for certain adults without symptoms at high risk
Preventive Care Benefits for Women
Services for pregnant women or women who may become pregnant
- Breastfeeding support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
- Birth control: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
- Folic acid supplements for women who may become pregnant
- Gestational diabetes screening for women 24 weeks pregnant (or later) and those at high risk of developing gestational diabetes
- Gonorrhea screening for all women at higher risk
- Hepatitis B screening for pregnant women at their first prenatal visit
- Maternal depression screening for mothers at well-baby visits
- Preeclampsia prevention and screening for pregnant women with high blood pressure
- Rh incompatibility screening for all pregnant women and follow-up testing for women at higher risk
- Syphilis screening
- Expanded tobacco intervention and counseling for pregnant tobacco users
- Urinary tract or other infection screening
Other covered preventive services for women
- Bone density screening for all women over age 65 or women age 64 and younger that have gone through menopause
- Breast cancer genetic test counseling (BRCA) for women at higher risk
- Breast cancer mammography screenings
- Every 2 years for women 50 and over
- As recommended by a provider for women 40 to 49 or women at higher risk for breast cancer
- Breast cancer chemoprevention counseling for women at higher risk
- Cervical cancer screening
- Pap test (also called a Pap smear) for women age 21 to 65
- Chlamydia infection screening for younger women and other women at higher risk
- Diabetes screening for women with a history of gestational diabetes who aren’t currently pregnant and who haven’t been diagnosed with type 2 diabetes before
- Domestic and interpersonal violence screening and counseling for all women
- Gonorrhea screening for all women at higher risk
- HIV screening and counseling for everyone age 15 to 65, and other ages at increased risk
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative women at high risk for getting HIV through sex or injection drug use
- Sexually transmitted infections counseling for sexually active women
- Tobacco use screening and interventions
- Urinary incontinence screening for women yearly
- Well-woman visits to get recommended services for all women
Preventive Care Benefits for Children
Coverage for children’s preventive health services
- Alcohol, tobacco, and drug use assessments for adolescents
- Autism screening for children at 18 and 24 months
- Behavioral assessments for children: Age 0 to 17 years
- Bilirubin concentration screening for newborns
- Blood pressure screening for children: Age 0 to 17
- Blood screening for newborns
- Depression screening for adolescents beginning routinely at age 12
- Developmental screening for children under age 3
- Dyslipidemia screening for all children once between 9 and 11 years and once between 17 and 21 years, and for children at higher risk of lipid disorders
- Fluoride supplements for children without fluoride in their water source
- Fluoride varnish for all infants and children as soon as teeth are present
- Gonorrhea preventive medication for the eyes of all newborns
- Hearing screening for all newborns; and regular screenings for children and adolescents as recommended by their provider
- Height, weight and body mass index (BMI) measurements taken regularly for all children
- Hematocrit or hemoglobin screening for all children
- Hemoglobinopathies or sickle cell screening for newborns
- Hepatitis B screening for adolescents at higher risk
- HIV screening for adolescents at higher risk
- Hypothyroidism screening for newborns
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adolescents at high risk for getting HIV through sex or injection drug use
Immunizations for children from birth to age 18 — doses, recommended ages, and recommended populations vary:
- Chickenpox (Varicella)
- Diphtheria, tetanus, and pertussis (DTaP)
- Haemophilus influenza type b
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Inactivated Poliovirus
- Influenza (flu shot)
- Measles
- Meningococcal
- Mumps
- Pneumococcal
- Rubella
- Rotavirus
Lead screening for children at risk of exposure
Obesity screening and counseling
- Oral health risk assessment for young children from 6 months to 6 years
- Phenylketonuria (PKU) screening for newborns
- Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
- Tuberculin testing for children at higher risk of tuberculosis: Age 0 -17
- Vision screening for all children
- Well-baby and well-child visits
Ready to sign up for Bronze Select NS INN Univera PPO Local Adult/Family Dental Dep25 Preventive Rx Acupuncture?
Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904