Acom Benefit Guide - Class 1 - Officers, Directors

Preventative Health Care

Child preventive services Preventive office visits are covered, as well as the screenings, immunizations, counseling and supplements listed below.

Immunizations (vaccines for children from birth to age 18—doses, ages and populations vary) 2 Chickenpox/varicella Covid-19 ages 12 and up (within scope of Emergency Use Authorization) Haemophilus influenzae type B Hepatitis A Hepatitis B Human papillomavirus (HPV) Inactivated poliovirus Influenza Measles, mumps, rubella (MMR) Meningococcal Pneumococcal Rotavirus Tetanus, pertussis, diphtheria (Tdap) Counseling Obesity Comprehensive, intensive behavioral interventions to promote improvements in weight status Sexually transmitted infections (STI) Prevention counseling for adolescents at higher risk 1 Skin cancer Brief counseling for children and adolescents to minimize their exposure to ultraviolet radiation Tobacco smoking cessation Education or brief counseling to prevent initiation of tobacco use in school-aged children and adolescents

Screenings Alcohol and drug use

Assessments for adolescents

Autism

Screening for children at 18–24 months Assessments for children of all ages Screening for adolescents aged 12–18 Screening for children under age 3, and surveillance throughout childhood

Behavioral Depression

Developmental

Dyslipidemia

Screening for children at higher risk of lipid disorders 1

Height, weight and body mass index Hemoglobinopathies

Measurements for children of all ages

Screening for sickle cell disease in newborns Screening for adolescents at higher risk 1

Hepatitis B

Hypothyroidism

Screening for newborns

HIV

Screening for adolescents at higher risk 1 Screening for children at risk of exposure For all children throughout development Screening for children aged 6 or older Risk assessment for young children

Lead

Medical history

Obesity

Oral health

Phenylketonuria (PKU) Screening for newborns Sexually transmitted infection

Screening for adolescents at higher risk 1

Tuberculin

Testing for children at higher risk of tuberculosis 1

Vision Screening for all children between the ages 3–5 years old Medications and supplements (covered with a doctor’s prescription) Fluoride supplement Oral supplements starting at age 6 months for children without fluoride in their water sources

Fluoride varnish

Application by a primary care clinician to primary teeth starting at tooth eruption through age 5 Preventive medicine for the eyes of all newborns PrEP pre-exposure phophylaxis with effective antiretroviral therapy to persons at high risk of HIV acquisition 1 Supplements for children ages 6–12 months at risk for anemia

Gonorrhea

HIV pre-exposure prophylaxis

Iron

Refer to your Certificate of Coverage for details about all the covered services and benefit levels.

15 Acom Integrated Solutions 2022 Enrollment Guide 1 For more information on the definition of higher or increased risk and age recommendations, please see the US Preventive Guidelines at http://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-and-b-recommendations. 2 For more information on immunization recommendations, resources and schedules, please refer to the Centers for Disease Control and Prevention at www.cdc.gov/vaccines/schedules/index.html. This communication provides a general description of certain identified insurance or non-insurance benefits provided under one or more of our health benefit plans. Our health benefit plans have exclusions and limitations and terms under which the coverage may be continued in force or discontinued. For costs and complete details of the coverage, refer to the plan document or call or write Humana, or your Humana insurance agent or broker. In the event of any disagreement between this communication and the plan document, the plan document will control.

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