Health screenings and interventions (continued)
SERVICE
GROUP AGE, FREQUENCY
Prostate cancer screening (PSA)
Men ages 50 and older or age 40 with risk factors
Preeclampsia screening (blood pressure measurement)
Pregnant women
Rh incompatibility test
Pregnant women
Sexually transmitted infections (STI) counseling
Sexually active women, annually; sexually active adolescents; and men at increased risk
Sexually transmitted infections (STI) screening
Adolescents ages 11–21
Sickle cell disease screening
Newborns
Skin cancer prevention counseling to minimize exposure to ultraviolet radiation
Ages 6 months–24 years
Syphilis screening
Individuals at risk; pregnant women
Tobacco use cessation: counseling/interventions 1
All adults 1 ; pregnant women
Tobacco use prevention (counseling to prevent initiation)
School-age children and adolescents
Tuberculosis screening
Children, adolescents and adults at risk
Ultrasound aortic abdominal aneurysm screening
Men ages 65–75 who have ever smoked
Urinary incontinence screening
Women
Vision screening (not complete eye examination)
Ages 3, 4, 5, 6, 8, 10, 12, and 15 or as doctor advises
= Men
= Women
= Children/adolescents
1. Subject to the terms of your plan’s pharmacy coverage, certain drugs and products may be covered at 100%. Your doctor is required to give you a prescription, including for those that are available over the counter, for them to be covered under your Pharmacy benefit. Cost sharing may be applied for brand-name products where generic alternatives are available. Please refer to Cigna’s“No Cost Preventive Medications by Drug Category”Guide for information on drugs and products with no out-of-pocket cost. 2. Subject to the terms of your plan’s medical coverage, home blood pressure monitoring supplies, breast-feeding equipment rental and supplies may be covered at the preventive level. Your doctor is required to provide a prescription, and the equipment and supplies must be ordered through CareCentrix, Cigna’s national durable medical equipment vendor. Precertification is required for some types of breast pump equipment. To obtain home blood pressure monitoring equipment, breast pump and breast pump supplies, contact CareCentrix at 844.457.9810 . 3. Examples include oral contraceptives; diaphragms; hormonal injections and contraceptive supplies (spermicide, female condoms); emergency contraception. 4. Subject to the terms of your plan’s medical coverage, contraceptive products and services such as some types of IUDs, implants and sterilization procedures may be covered at the preventive level. Check your plan materials for details about your specific medical plan. These preventive health services are based on recommendations from the U.S. Preventive Services Task Force (A and B recommendations), the Advisory Committee on Immunization Practices (ACIP) for immunizations, the American Academy of Pediatrics’Periodicity Schedule of the Bright Futures Recommendations for Pediatric Preventive Health Care, the Uniform Panel of the Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children and, with respect to women, evidence-informed preventive care and screening guidelines supported by the Health Resources and Services Administration. For additional information on immunizations, visit the immunization schedule section of www.cdc.gov . This document is a general guide. Always discuss your particular preventive care needs with your doctor. Some plans choose to supplement the preventive care services listed above with a few additional services, such as other common laboratory panel tests. When delivered during a preventive care visit, these services also may be covered at the preventive level. Exclusions This document provides highlights of preventive care coverage generally. Some preventive services may not be covered under your plan. For example, immunizations for travel are generally not covered. Other non-covered services/supplies may include any service or device that is not medically necessary or services/supplies that are unproven (experimental or investigational). For the specific coverage terms of your plan, refer to your plan documents. If there are any differences between the information displayed here and the official plan documents, the terms of the plan documents will control. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC), Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation, including Cigna HealthCare of Arizona, Inc., Cigna HealthCare of California, Inc., Cigna HealthCare of Colorado, Inc., Cigna HealthCare of Connecticut, Inc., Cigna HealthCare of Florida, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Indiana, Inc., Cigna HealthCare of St. Louis, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of New Jersey, Inc., Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of Tennessee, Inc. (CHC-TN), and Cigna HealthCare of Texas, Inc. Policy forms: OK - HP-APP-1 et al., OR - HP-POL38 02-13, TN - HP-POL43/HC-CER1V1 et al. (CHLIC); GSA-COVER, et al. (CHC-TN). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 855050 h 01/19 © 2019 Cigna. Some content provided under license. 9
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