A list of Cigna's Preventive Healthcare Exams, Immunizations, Interventions and Screenings
Preventive health care. Understanding what’s covered.
What is preventive care? Preventive care is a specific group of services
What’s not considered preventive care? Once you have a symptom or your health care provider diagnoses a health issue, additional tests are not considered preventive care. Also, you may receive other medically appropriate services during a periodic wellness exam that are not considered preventive. These services may be covered under your plan’s medical benefits, not your preventive care benefits. This means you may be responsible for paying a share or all of the cost depending on your plan, including deductible, copay or coinsurance amounts. Which preventive services are covered? Many plans cover preventive care at no additional cost to you when you use a health care provider in your plan’s network. Use the provider directory on myCigna.com ® for a list of in-network health care providers and facilities. See the following pages for the services and supplies considered preventive care under most health plans. Coverage for services recommended specifically for “men” or “women” is provided based on the anatomical characteristics of the individual and not necessarily the gender of the individual as indicated on the claim and/or an enrollment form.
recommended when you don’t have any symptoms and haven’t been diagnosed with a related health issue. It includes your periodic wellness exam (check-up) and specific tests, certain health screenings, and most immunizations. Most of these services typically can take place during the same visit. You and your health care provider will decide what preventive services are right for you, based on your: • Age • Gender • Personal health history • Current health Why do I need preventive care? Preventive care can help you detect problems at early stages, when they may be easier to treat. It can also help you prevent certain illnesses and health conditions from happening. Even though you may feel fine, getting your preventive care at the right time can help you take control of your health. Make a plan for preventive care. Use this space to write down the details for your next periodic wellness exam.
Questions? Check your plan materials, talk with your health care provider or call the number on the back of your ID card.
Date: Time: Questions for my provider:
Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company or their affiliates.
855050 s 05/24
Wellness exams
SERVICE
GROUP CRITERIA AND FREQUENCY
Well-baby/well-child/well-person exams, including annual well-woman exam (includes height, weight, head circumference, BMI, blood pressure, history, anticipatory guidance, education regarding risk reduction, psychosocial/behavioral assessment)
• Birth, 1, 2, 4, 6, 9, 12, 15, 18, 24 and 30 months • Additional visit at 2–4 days for infants discharged less than 48 hours after delivery • Ages 3 to 21, once a year • Ages 22 and older, periodic visits as doctor advises
Routine immunizations covered under preventive care
• COVID-19 • Diphtheria, Tetanus Toxoids and Acellular Pertussis (DTaP, Tdap, Td) • Haemophilus influenzae type b conjugate (Hib)
• Meningococcal (meningitis) • Pneumococcal (pneumonia) • Poliovirus (IPV) • Respiratory Syncytial Virus (RSV) • Rotavirus (RV) • Varicella (chickenpox) • Zoster (shingles)
• Hepatitis A (Hep A) • Hepatitis B (Hep B) • Human papillomavirus (HPV) • Influenza vaccine • Measles, mumps and rubella (MMR)
You may view the immunization schedules on the CDC website: cdc.gov/vaccines/schedules/ .
Health screenings and interventions
SERVICE
GROUP CRITERIA AND FREQUENCY
Abnormal blood glucose and type 2 diabetes screening/counseling
Adults ages 40–70 who are overweight or obese; women with a history of gestational diabetes mellitus Adults; children and adolescents, ages 8–18, includes pregnant and postpartum persons
Anxiety screening
Aspirin to reduce risk for preeclampsia 1
Adults ages 50–59 with risk factors; pregnant women at risk for preeclampsia
Autism screening
18, 24 months
Bacteriuria screening
Pregnant women
Bilirubin screening
Newborns before discharge from hospital
Breast cancer screening (mammogram)
Women ages 40 and older, every 1–2 years
Breast cancer-discussion of benefits/risks of preventive medication
Women ages 35 and older at risk
During pregnancy and after birth
Breast-feeding support/counseling, supplies 2
Cervical cancer screening (Pap test) HPV DNA test alone or with Pap test
Women ages 21–65, every 3 years Women ages 30–65, every 3 years Sexually active women at risk
Chlamydia screening
Cholesterol/lipid disorders screening 1
• Screening of children and adolescents ages 9–11 years and 17–21 years; children and adolescents with risk factors ages 2–8 and 12–16 years • All adults ages 40–75
= Men
= Women
= Children/adolescents
(continued)
Health screenings and interventions
SERVICE
GROUP CRITERIA AND FREQUENCY
The following tests will be covered for colorectal cancer screening, ages 45–75: • Fecal occult blood test (FOBT) or fecal immunochemical test (FIT) annually • Flexible sigmoidoscopy every 5 years • Flexible sigmoidoscopy every 10 years + annual FIT • Double-contrast barium enema (DCBE) every 5 years • Colonoscopy every 10 years, including a follow-up colonoscopy, for when stool-based tests reveal abnormal results • Computed tomographic colonography (CTC)/virtual colonoscopy every 5 years – Requires prior authorization • Stool-based deoxyribonucleic acid (DNA) test (i.e., Cologuard) every 1–3 years
Colon cancer screening 1
Congenital hypothyroidism screening
Newborns
Critical congenital heart disease screening
Newborns before discharge from hospital
Contraception counseling/education (including fertility awareness-based methods); contraceptive products and services 1, 3, 4 Dental application of fluoride varnish to primary teeth at time of eruption (in primary care setting) Dental caries prevention Evaluate water source for sufficient fluoride; if deficient prescribe oral fluoride 1
Women with reproductive capacity
Children to age 6 years
Children older than 6 months
Depression screening/Maternal depression screening
Adults; Adolescents ages 12–18, including pregnant and postpartum women
9, 18, 30 months
Developmental screening
Newborn, 1, 2, 4, 6, 12, 15, 24 months. At each visit ages 3–21
Developmental surveillance
Community-dwelling adults ages 65 and older with risk factors
Fall prevention in older adults (including assessment of risk, individual and group exercise, and physical therapy)
Folic acid supplementation 1
Women planning or capable of pregnancy
Women at risk, including those with a personal or family history of breast cancer, ovarian cancer, tubal cancer or peritoneal cancer, or an ancestry associated with BRCA 1/2 gene mutation • Genetic counseling must be provided by an independent board-certified genetic specialist prior to BRCA1/BRCA2 genetic testing • BRCA1/BRCA2 testing requires precertification Pregnant women with no symptoms of diabetes, at 24 weeks of pregnancy or after
Genetic counseling/evaluation and BRCA1/BRCA2 testing
Gestational diabetes screening
Sexually active women age 24 years and younger and older women at risk
Gonorrhea screening
Ages 6 and older, including pregnant persons – to promote healthy weight status; individuals with risk factors for cardiovascular disease; behavioral health counseling while pregnant All newborns by 2 months. Ages 4, 5, 6, 8, 10. Adolescents once between ages 11–14, 15–17 and 18–21
Healthy diet and physical activity counseling
Hearing screening (not complete hearing examination)
Hemoglobin or hematocrit
12 months
Pregnant women; adolescents and adults at risk
Hepatitis B screening
Adults ages 18–79
Hepatitis C screening
Adults ages 18 and older without known high blood pressure
High blood pressure screening (outside clinical setting) 2
HIV Preexposure Prophylaxis (PrEP) for prevention of HIV infection 1 HIV PrEP related services (HIV screening, kidney function testing, hepatitis B & C screening, pregnancy testing, sexually transmitted infection screening/behavioral counseling, adherence counseling)
Individuals at risk
= Men
= Women
= Children/adolescents
(continued)
Health screenings and interventions
SERVICE
GROUP CRITERIA AND FREQUENCY
Pregnant women; adolescents and adults 15 to 65 years; younger adolescents and older adults at risk; sexually active women (adolescent/adult), annually
HIV screening and counseling
Intimate partner/interpersonal violence screening
All women (adolescent/adult)
12, 24 months
Lead screening
Adults ages 50–80 with 20 pack year smoking history, and currently smoke, or have quit within the past 15 years. Computed tomography requires precertification
Lung cancer screening (low-dose computed tomography)
Metabolic/hemoglobinopathies (according to state law)
Newborns
Ages 6 and older, all adults
Obesity screening/counseling
Newborns
Ocular (eye) medication to prevent blindness
6, 9 months. Ages 12 months, 18 months–6 years for children at risk
Oral health evaluation/assess for dental referral
Age 65 or older (or under age 65 for women with fracture risk as determined by a Clinical Risk Assessment Tool). Computed tomographic bone density study requires precertification
Osteoporosis screening
PKU screening
Newborns
Pregnant and postpartum women with risk factors
Perinatal depression preventive counseling
Hypertensive disorders of pregnancy screening (blood pressure measurement)
Pregnant women
Men ages 45 and older or age 40 with risk factors
Prostate cancer screening (PSA)
Pregnant women
Rh incompatibility test
Sexually active women, annually; sexually active adolescents; and men at increased risk
Sexually transmitted infections (STI) counseling Sexually transmitted infections (STI) screening
Adolescents ages 11–21
Newborns
Sickle cell disease screening
Skin cancer prevention counseling to minimize exposure to ultraviolet radiation Statin use for the primary prevention of cardiovascular disease
Ages 6 months–24 years
Adults ages 40–75 who have cardiovascular disease risk factors
Individuals at risk; pregnant women
Syphilis screening
All adults 1 ; pregnant women
Tobacco use cessation: counseling/interventions 1
School-age children and adolescents Children, adolescents and adults at risk Men ages 65–75 who have ever smoked
Tobacco use prevention (counseling to prevent initiation)
Tuberculosis screening
Ultrasound aortic abdominal aneurysm screening Unhealthy alcohol use and substance abuse screening
All adults; adolescents age 11–21
All adults
Unhealthy drug use screening Urinary incontinence screening
Women
Ages 3, 4, 5, 6, 8, 10, 12, and 15 or as doctor advises
Vision screening (not complete eye examination)
= 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 (unless your state does not require a prescription for OTC products), 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 for home blood pressure monitoring equipment and some breast pump equipment. 3.Examples include oral contraceptives; diaphragms; hormonal injections and contraceptive supplies (spermicide, condoms); emergency contraception. 4. Subject to the terms of your plan’s medical coverage, contraceptive products and services such as some types of IUD’s, 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 the Evidence of Coverage, Summary Plan Description or Insurance Certificate. Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna Healthcare representative. All Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company (CHLIC), Connecticut General Life Insurance Company, Evernorth Care Solutions, Inc., Evernorth 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, OR - HP-POL3812-13 TN - HP-POL43/HC- CER1V1 et al. (CHLIC); GSA-COVER, et al. (CHC-TN). The Cigna Healthcare name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 855050 s 05/24 © 2024 Cigna Healthcare. Some content provided under license.
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