Preventive Care Services

Preventive Care Services

The preventive services listed below are available to Blue Cross of Idaho members with no-cost sharing when provided by an in-network provider per the requirements of the Patient Protection and Affordable Care Act (PPACA). Some assessments or services are included as part of the preventive office visit.

Preventive services include, but are not limited to, services like annual adult physical examinations and routine or scheduled well-baby and well-child examinations. Blue Cross of Idaho may adjust specifically listed preventive services to coincide with new or revised laws or regulations. Additionally, some services are subject to certain limitations depending on medical necessity and other reasonable medical management techniques.

This information is intended as a reference tool and is not a guarantee of payment. Review your healthcare plan for coverage details or call customer service at the number on the back of your ID card for assistance.

Preventive care covered services include services and tests awarded an A and B rating from the U.S. Preventive Services Task Forces (USPSTF) and the Health Resources and Services Administration (HRSA).

If you are on a Grandfathered Plan, please refer to your Enrollee Certificate for Preventive/Wellness Benefits.

Preventive Care Visits for Children and Teens

Talk with your doctor about frequency of visits. At a minimum, your child should visit the doctor at these ages.

  FrequencyServices That May Be Part of Wellness Visits
0-2

Birth to 2 weeks
2 months
4 months
6 to 9 months
12 months
15 months
18 months

Wellness visits typically include the following in combination with other preventive services outlined in this document:

History
Physical Exam (including blood pressure, height and weight)
Hearing and Vision Screening
Developmental and Behavioral Assessment

2-6

2 years
4 to 6 years

7-12

7 to 9 years
12 years

13-18

One to two visits between the ages of 13
and 18

Counseling and education as appropriate for all groups.

0-2

Iron Supplementation

If your child is 6 to 12 months old, talk with your doctor about
whether an iron supplement is needed.

Newborn screenings

Talk with your child's physician about these tests prior to your
delivery date - PKU, congenital hypothyroidism, sickle cell disease,
hearing and gonorrhea prophylactic eye medication.

0-18+

Dental Care

Regular screenings and cleanings encouraged starting at 6
months.

Hematocrit or Hemoglobin

Talk with your doctor about screening for anemia if your child has
special health care needs such as poor dietary intake.

Dyslipidemia (Lipid) screening

Talk with your doctor about screening for lipids (cholesterol,
triglycerides or fats) in the blood if your child has certain risk
factors such as a body mass index (BMI) at or above the 85%
percentile for age/gender, dietary or physical activity concerns
or a family history of elevated blood cholesterol, stroke or heart
problems.

Lead screening

Talk with your doctor about screening if your child has a risk of
being exposed to lead paint.

Tuberculosis (TB) skin test

Talk with your doctor about the skin test if your child has certain
risk factors such as birth place in or travel to a country at high
risk for TB or exposure to a person with tuberculosis or a positive
TB skin test.

Oral flouride Supplementation

Talk to your doctor about oral flouride supplementation if your
child is older than 6 months and your primary source of water is
flouride deficient.

Immunizations

Review with your doctor and visit http://www.cdc.gov/vaccines/
schedules/ for current childhood and adolescent immunization
and catch-up schedules.

2-18+

Obesity screening and counseling

Record height, weight and calculate body mass index (BMI)
annually. If your child is 6 years or older and has a BMI at or
above the 95th percentile for age/gender, talk to your doctor about
counseling and interventions to promote improvement in weight
status.

10-18+

Skin cancer behavioral counseling

If your child or teen has fair skin, talk with your doctor about
ways to reduce exposure to UV radiation to reduce the risk of skin
cancer.

12-18+

Depression screening

Adolescents 12 - 18 years of age should be screened for
depression and referred as needed for follow up and counseling.

13-18+

Cervical dysplasia screening
(Pap smear)

Sexually active females within three years of onset of sexual
activity no later than age 21 should be screened.

Chlamydia screening

Sexually active females 24 years and younger should be screened.

HIV screening

Adolescents and adults ages 15 to 65 years, younger adolescents
at increased risk, and with each pregnancy. Repeat screening
may be indicated, particularly for individuals at risk. Talk with
your doctor about screening.

Sexually transmitted infections (STIs)
prevention counseling

If your adolescent is sexually active, talk to your doctor about
behavioral counseling to prevent STIs.

13-18+

Alcohol or drug use screening

Talk to your doctor if concerned about the risk of your child using
alcohol or drugs.

Tobacco use and cessation

If your child smokes or uses other tobacco products, talk to your
doctor about cessation programs.

Preventive Screening and Education Recommendations for Adults

  Men

Abdominal Aortic Aneurysm

Ages 65 to 75 who have ever smoked (more than 100 cigarettes in a lifetime) should receive a one-time screening.

Cholesterol abnormalities screen (total cholesterol, high-density and low-density lipoprotein)

Every five years for age 35 and older for men. Younger men with other risk factors for coronary disease.

Men and Women

Aspirin for prevention of cardiovascular disease

Talk to your doctor about using aspirin if you are a man age 45 or older, or a woman age 55 or older, or a yonger individual with additional risk factors.

Colorectal cancer screening

Recommend screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy or colonoscopy for ages 50 to 75 at appropriate intervals depending upon the method of screening chosen. The risks and benefits of these screening methods vary and should be discussed with your doctor.

Depression Screening

Talk to your doctor about any warning signs such as feeling sad or having lost interest in things you used to like to do.

Diabetes mellitus

If you have hypertension, defined as sustained blood pressure greater than 135/80 mm Hg, ask your doctor about screening for Type 2 diabetes.

Diet/nutrition

If you have risk factors for cardiovascular and diet-related chronic disease, talk to your doctor about behavioral counseling to promote a healthy diet. You are also eligible for three visits with a registered dietician to learn more about your personal diet and nutrional needs.

High blood pressure screening

Every 2 years if less than 120/80; annually if over 120/80 in either number.

Obesity screening and counseling

Record height, weight and body mass index (BMI) at least annually. If your BMI is over 30, talk to your doctor about sustained weight-loss counseling and supportive services.

Fall risk screening and prevention

If you’re 65 years or older, talk to your doctor about a falls risk screening and if exercise and therapy counseling and vitamin D supplementation are appropriate for you.

Hepatitis C virus (HCV) infection screening

If you are at high risk for HCV infection, talk with your doctor about periodic screening. If you are an adult born between 1945 and 1965, a one time screening is recommended.

Sexually transmitted infections (STIs) prevention counseling

Talk with your doctor about your risk factors. Men and women at increased risk should receive behavioral counseling to prevent future STIs.

Men, Women and Pregnant Women

Alcohol misuse screening and behavioral counseling interventions

Talk to your doctor about your alcohol use..

HIV Screening

Screening for adolescents and adults ages 15 to 65 years, older adults at increased risk, and with each pregnancy. Repeat screening may be indicated, particularly for individuals at risk. Talk with your doctor.

Immunizations

Review with your doctor and visit http://www.cdc.gov/vaccines/schedules/ for current immunization schedule.

Syphilis infection screening

Men and women at increased risk, and all pregnant women should be screened.

Tobacco use and cessation

Have you tried to stop smoking before? Have you tried to stop using other tobacco products? Are you thinking about stopping now? Talk to your doctor about smoking/tobacco cessation and call the Customer Service Department number listed on the back of your identification card to ask about our smoking/tobacco cessation programs.

Women

Breast cancer screening

Mammography every 1 to 2 years for ages 40 and older.

Breast cancer preventive medication

If you are at high risk for breast cancer, talk to your doctor about using preventive medication.

Breast and ovarian cancer susceptiility

If you have a family history of breast cancer, talk to your doctor. Women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes should be referred for genetic counseling and evaluation for BRCA testing.

Cervical cancer screening with optional screening for Human papillomarius (HPV)

Ages 21 - 29: every three years with cytology (pap smear).
Ages 30 - 65: screening with cytology (pap smear) every three
years. If you are interested in lengthening the screening
interval, discuss with your provider the option of combination
screening with cytology and human papillomavirus (HPV) testing
every five years.
Over 65: talk to your doctor about screening.
Any age: If you have had a hysterectomy, talk to your doctor
about whether continued screening is recommended.

Cholesterol abnormalities screen (total cholesterol, high-density and low-density lipoprotein)

Every five years for age 45 and older for women. Younger women with other risk factors for coronary disease.

Contraceptive Methods, Pharmacy, and counseling (excluding over-the-counter)

Women’s preventive contraceptive prescription drugs, devices and surgical sterilization as specifically listed below will be covered at 100%. The day supply allowed shall not exceed a 90-day supply at one(1) time, as applicable to the specific contraceptive drug or supply. Covered services include prescribed hormone contraceptive pills, diaphrams, intrauterine devices (IUDs), implantables, injections and tubal ligation.

Folic acid supplements

Women of child-bearing age should take a daily supplement containing 400 to 800 micrograms of folic acid.

Osteoporosis screening (bone density testing)

Women 65 years and older, and younger women with same or greater fracture risk.

Pregnant Women

Anemia screening

Asymptomatic pregnant women should be screened.

Bacteriuria screening

At 12 - 16th week of pregnancy or first prenatal visit (if later).

Diabetes, Screening for Gestational
Diabetes

Between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes.

Hepatitis B virus infection screening

At first prenatal visit.

Rh incompatibility

Ask your doctor if you should be tested for Rh incompatibility. Some women may need repeat testing.

Women and Pregnant Women

Breastfeeding support,supplies and
counseling

Talk to your doctor about breastfeeding your baby. Lactation or breastfeeding support and counseling is a covered benefit during pregnancy or in the postpartum period in conjunction with the birth of each child. Costs are covered at 100% for the rental or purchase of breastfeeding equipment and covered supplies per benefit period if purchased from a participating durable medical equipment (DME) vendor. Rental of a ‘hospital grade’ breast pump requires prior authorization.

Chlamydia screening

Sexually active females 24 years and younger and older women with increased risk.
Asymptomatic pregnant women 24 years and younger and older pregnant women at increased risk.

Gonorrhea screening

Sexually active women at increased risk of infection.

Intimate partner violence screening and
intervention.

Women of childbearing age should be screened for intimate partner violence such as domestic violence. Talk to your doctor about this screening and referrals for needed support, counseling and treatment.

Additional BCI Covered Services

In addition to the above listed services, Blue Cross of Idaho considers the following services to be covered when billed as part of a Wellness or Preventive Visit.

Chemistry/Metabolic or Lipid Panels, Complete Blood Count(CBC), PSA Test, Rubella, Screening EKG, Thyroid Stimulating Hormone (TSH), Tuberculois Skin Test and Urinalysis (UA).

Blue Cross of Idaho provides benefits for in-network preventive services if it is an evidence-based service or it has an A or B rating from the United States Preventive Services Task Force and the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and Health Resources and Services Administration.

  • Blue Cross of Idaho adopts evidenced-based preventive health guidelines in an effort to improve healthcare quality and reduce unnecessary variation in care.
  • We encourage the appropriate use of preventive services to our members according to age, gender, and risk-status. These include screenings, immunizations, and physical examinations.
  • Our Physician Advisory Panel reviews and approves our preventive standards no less than every two years or if there are significant changes.