Section 5(a). In-network preventive care

Subsections:

Preventive care, adult

Preventive care, children

		Here are some important things you should keep in mind about these in-network preventive care benefits: Under the Consumer Driven Option, the plan pays 100% for the preventive care services listed in this Section as long as you use a network (PPO) provider. For preventive care not listed in this Section or for preventive care from a non-network provider, please see CDHP Section 5(b) – Personal Care Account (PCA). For all other covered expenses, please see CDHP Section 5(b) – Personal Care Account and Section 5(c) – Traditional Health Coverage. Note that the in-network preventive care paid under this Section does NOT count against or use up your Personal Care Account (PCA). Under the Consumer Driven Option, there is no calendar year deductible Please remember that all benefits are subject to the definitions, limitations and exclusions in this brochure and are payable only when we determine they are medically necessary. Be sure to read Section 4, Your costs for covered services, for valuable information about how cost sharing works, with special sections for members who are age 65 or over. Also read Section 9 about coordinating benefits with other coverage, including with Medicare.
Benefit Description			You Pay
NOTE: There is no calendar year deductible under the Consumer Driven Option.
Preventive care, adult
One annual routine office visit and examination per person after age 18			Nothing
Adult routine immunizations endorsed by the Centers for Disease Control and Prevention (CDC).			Nothing
Routine screenings: Total Blood Cholesterol, once annually Fasting lipoprotein profile, once every 5 years for adults age 20 or older Osteoporosis screening, once every two years, for women age 65 and older Chlamydial infection Routine mammograms covered for women age 35 and older, as follows: From age 35 through 39, one during this five year period From age 40 through 64, one every calendar year At age 65 and older, one every two consecutive calendar years Pap Smear and Routine Pelvic Exam annually Colorectal Cancer Screenings, member has the choice of the following: Fecal occult blood test (FOBT) annually and flexible sigmoidoscopy once every 5 years, both beginning at age 50; or Colonoscopy once every 10 years beginning at age 50; or Double contrast barium enema (DCBE) once every five years starting at age 50 Digital rectal examination (DRE) and prostate specific antigen (PSA) test annually starting at age 45 Abdominal Aortic Aneurysm screening, once for men between the ages of 65 and 75 with a smoking history.			Nothing
Preventive care, children			You Pay
Routine office visits, examinations and laboratory tests as follows: Six visits the first year (to age 1) Three visits the second year (age 1-2) Annual visits from age 2 through age 18			Nothing
Childhood immunizations recommended by the American Academy of Pediatrics up to age 22			Nothing
Routine screenings: One Screening Examination of Premature Infants for Retinopathy of Prematurity or infants with low birth weight or gestational age of 32 weeks or less Lead level testing, one between ages 9 to 12 months and one between 12 and 24 months Vision screening at ages 3, 4, 5, 6, 8, 10, 12, 15, and 18 Hearing screening at ages 4, 5, 6, 8, 10, 12, 15, and 18 Pap smear and routine pelvic exam annually beginning at age 18 or the onset of sexual activity, whichever comes first.			Nothing

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