HMSA Individual Dental PPO Pediatric Essential

Preventive care benefits for adults

1. Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
2. Alcohol misuse screening and counseling
3. Aspirin use to prevent cardiovascular disease and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk
4. Blood pressure screening
5. Cholesterol screening for adults of certain ages or at higher risk
6. Colorectal cancer screening for adults 45 to 75
7. Depression screening
8. Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese
9. Diet counseling for adults at higher risk for chronic disease
10. Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over, living in a community setting
11. 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.
12. Hepatitis C screening for adults age 18 to 79 years
13. HIV screening for everyone age 15 to 65, and other ages at increased risk
14. PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adults at high risk for getting HIV through sex or injection drug use
15. 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
16. 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
17. Obesity screening and counseling
18. Sexually transmitted infection (STI) prevention counseling for adults at higher risk
19. Statin preventive medication for adults 40 to 75 at high risk
20. Syphilis screening for adults at higher risk
21. Tobacco use screening for all adults and cessation interventions for tobacco users
22. Tuberculosis screening for certain adults without symptoms at high risk

Services for pregnant women or women who may become pregnant

1. Breastfeeding support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
2. 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.”
3. Folic acid supplements for women who may become pregnant
4. Gestational diabetes screening for women 24 weeks pregnant (or later) and those at high risk of developing gestational diabetes
5. Gonorrhea screening for all women at higher risk
6. Hepatitis B screening for pregnant women at their first prenatal visit
7. Maternal depression screening for mothers at well-baby visits
8. Preeclampsia prevention and screening for pregnant women with high blood pressure
9. Rh incompatibility screening for all pregnant women and follow-up testing for women at higher risk
10. Syphilis screening
11. Expanded tobacco intervention and counseling for pregnant tobacco users
12. Urinary tract or other infection screening

Other covered preventive services for women

1. Bone density screening for all women over age 65 or women age 64 and younger that have gone through menopause
2. Breast cancer genetic test counseling (BRCA) for women at higher risk
3. 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
4. Breast cancer chemoprevention counseling for women at higher risk
5. Cervical cancer screening
   • Pap test (also called a Pap smear) for women age 21 to 65
6. Chlamydia infection screening for younger women and other women at higher risk
7. 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
8. Domestic and interpersonal violence screening and counseling for all women
9. Gonorrhea screening for all women at higher risk
10. HIV screening and counseling for everyone age 15 to 65, and other ages at increased risk
11. PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative women at high risk for getting HIV through sex or injection drug use
12. Sexually transmitted infections counseling for sexually active women
13. Tobacco use screening and interventions
14. Urinary incontinence screening for women yearly
15. Well-woman visits to get recommended services for all women

Coverage for children’s preventive health services

1. Alcohol, tobacco, and drug use assessments for adolescents
2. Autism screening for children at 18 and 24 months
3. Behavioral assessments for children: Age 0 to 17 years
4. Bilirubin concentration screening for newborns
5. Blood pressure screening for children: Age 0 to 17
6. Blood screening for newborns
7. Depression screening for adolescents beginning routinely at age 12
8. Developmental screening for children under age 3
9. 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
10. Fluoride supplements for children without fluoride in their water source
11. Fluoride varnish for all infants and children as soon as teeth are present
12. Gonorrhea preventive medication for the eyes of all newborns
13. Hearing screening for all newborns; and regular screenings for children and adolescents as recommended by their provider
14. Height, weight and body mass index (BMI) measurements  taken regularly for all children
15. Hematocrit or hemoglobin screening for all children
16. Hemoglobinopathies or sickle cell screening for newborns
17. Hepatitis B screening for adolescents at higher risk
18. HIV screening for adolescents at higher risk
19. Hypothyroidism screening for newborns
20. PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adolescents at high risk for getting HIV through sex or injection drug use

21. 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

22. Lead screening for children at risk of exposure

23. Obesity screening and counseling

24. Oral health risk assessment for young children from 6 months to 6 years
25. Phenylketonuria (PKU) screening for newborns
26. Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
27. Tuberculin testing for children at higher risk of tuberculosis: Age 0 -17
28. Vision screening for all children
29. Well-baby and well-child visits