Preventive Guidelines (Members)
NOTICE: The preventive guidelines displayed below are intended as a resource for you to be able to know the services available to you as a member which are covered with no member cost share when received in-network. Benefits and services are subject to change by Alliant. To understand if you, the member, qualify for these benefits, refer to the your Certificate of Coverage or call Client Services at (866) 403-2785.
| Preventive Health Care Benefit | Frequency | Age Limits | |
|---|---|---|---|
| Abdominal Aortic Aneurysm Screening | 1 per lifetime | Men Ages 65-75 | |
| Abnormal Blood Glucose and Diabetes Screening and Counseling as part of cardiovascular risk assessment. Adults aged 40 to 70 who are overweight or obese; women with history of gestational diabetes mellitus | 1 per year Adults 1 per year Pregnant | Ages 40 to 70 Unless pregnant then no age limit | |
| Alcohol Substance Misuse | 1 per year | None | |
| Anemia Screening | 1 per year Pregnant | None | |
| Aspirin use for the prevention of preeclampsia for women over 12 weeks gestation and who are at high risk for preeclampsia | N/A | N/A | |
| Bacteriuria Screening: using urine culture in pregnant persons. | 1 per year Pregnant | None | |
| BART Testing | 1 per lifetime | None | |
| Bilirubin Screening: infants with gestational age of 35 weeks or greater | 1 per lifetime | Ages 0 - 8 Days | |
| BRCA Counseling | 1 per year | None | |
| BRCA Testing | 1 per lifetime | None | |
| Breast Cancer Chemoprevention | 1 per year for visit. No limit of fills on risk-reducing medications dispensed to member with a physician order with no cost-sharing | Female 35 years or older | |
| Breast Cancer Screening: MRI | 1 per year | Female 40 years of age or older unless considered high risk then is 39 years of age or younger | |
| Breast Cancer Screening: Mammograms and Digital Breast Tomosynthesis | 1 per year | Female 40 years of age or older unless considered high risk then is 39 years of age or younger | |
| Breastfeeding support, supplies, and counseling (Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for breastfeeding equipment) | See Other Requirements | None | |
| Cervical cancer/HPV screening | Women 21-29 years of age every 3 years by cytology and age 30-65 years of age every 3 years with cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) | Women 21-29 years of age every 3 years by cytology and age 30-65 years of age every 3 years with cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) | |
| Chlamydial Infection Screening | 1 per year and 1 per year pregnant | Women 24 and Older unless pregnant in which case there is no age limit | |
| Cholesterol Abnormalties/Lipid Disorder Screening | 1 per year | See other requirements | |
| Colorectal Cancer Screening - Colonoscopy | 1 per 10 years unless high risk in which case is 1 per 2 years | Ages 45-75 - Routine Ages 18-75 - High Risk | |
| Colorectal Cancer Screening - CT Colonography | 1 per 5 years | Ages 45-75 - Routine Ages 18-75 - High Risk | |
| Colorectal Cancer Screening - FIT | 1 per year | Ages 45-75 - Routine Ages 18-75 - High Risk | |
| Colorectal Cancer Screening - Sigmoidoscopy | 1 per 5 years unless high risk in which case is 1 per 2 years | Ages 45-75 - Routine Ages 18-75 - High Risk | |
| Colorectal Cancer Screening - Fecal DNA (Cologuard) | 1 per 3 years | Ages 45 - 75 - Routine | |
| Colorectal Cancer Screening - FOBT | 1 per year | Ages 45-75 Routine Ages 18-75 High Risk | |
| Contraceptive methods and counseling | N/A | N/A | |
| Depression Screening Adults (screening for depression, including pregnant and postpartum women, when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up) Adolescents (screening 12-18 yr olds for major depressive disorder when systems are in place to ensure accurate diagnosis, psychotherapy [cognitive-behavioral or interpersonal], and follow-up) | 1 per year | Ages 12 years and above | |
| Developmental Screening | 1 annually | Up to age 18 | |
| Emotional/behavioral assessment | 1 per year | None | |
| Fall Prevention (Exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls.) | 3 annual - any combination | Ages 65 and Older | |
| Flouride Varnish | 1 quarterly | Up to age 5 | |
| Folic Acid supplementation for all women planning or capable of pregnancy All women planning or capable of pregnancy to take a daily supplement containing 0.4 - 0.8 mg [400-600 mcg] of folic acid | N/A | N/A | |
| Gestational Diabetes Mellitus (GDM) Screening in asymptomatic pregnant women after 24 weeks of gestation. | 1 per pregnancy | None | |
| Gonorrhea Screening Women who are sexually active that are at increased risk for infection [if they are young or have other individual or population risk factors]) Pregnant Women | 1 per year 1 per year Pregnant | None | |
| Group B strep testing performed one time during pregnancy | 1 per pregnancy | None | |
| Hemoglobinopathies Screening (for sickle cell disease in newborns) | 1 per lifetime | Ages 0 - 8 Days | |
| Hepatitis B Screening (in pregnant women at first prenatal visit and in persons at high risk for infection.) | 1 per year Persons at high risk for infection and 1 per year Pregnant | Ages 13-79 unless pregnant then at any age | |
| Hepatitis C Virus (HCV) Screening (for persons at high risk for infection.) The USPSTF also recommends offering one-time screening for HCV infection to adults aged 18 to 79. | 1 every 10 years | Ages 18 - 79 | |
| High Blood Pressure Screening (Recommends screening for high blood pressure in adults aged 18 years or older. The USPSTF recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment) | Ages 18 and Older | ||
| HIV Infection Prevention with Preexposure prophylaxis (Persons at high risk of acquiring HIV. Offer preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition, including monitoring required prior to initiation of therapy and during drug therapy). | |||
| HIV Screening | 1 per year Persons at high risk and 1 per year Pregnant | Ages 15 - 65 unless pregnant then at any age | |
| Iron supplementation in children (routine iron supplementation for asymptomatic children 6-12 mo of age who are at increased risk for iron deficiency anemia) | N/A | N/A | |
| Lead Screening | 1 per year | Ages 7 and Under | |
| Lung Cancer Screen (LDCT) | 1 per year | Ages 50 - 80 | |
| Lung Cancer Screen (LDCT) Counseling | 1 per year | Ages 50 - 80 | |
| Nutritional Counseling Healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors. (Recommends offering or referring adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention.) | 1 - Preventive 4 - Medically Necessary | Ages 6 and Over | |
| Osteoporosis Screening - Bone density CT | 1 every two years | Age 65 and Older unless high risk in which case is age 20 and older | |
| Osteoporosis Screening - Bone density tests | 1 every two years | Age 65 and Older unless high risk in which case is age 20 and older | |
| PKU Screening (in newborns) | 1 per lifetime | Ages 0 - 8 Days | |
| Prophylactic medication for gonorrhea: newborns (ocular topical medication for all newborns against gonococcal ophthalmia neonatorum) | N/A | N/A | |
| Prostate Screening | 1 Annually | Males Ages 50 - 70 | |
| Rh(D) blood typing and antibody testing for all pregnant women | 2 per pregnancy - The USPSTF strongly recommends Rh(D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care. The USPSTF recommends repeated Rh(D) antibody testing for all unsensitized Rh(D)-negative women at 24 to 28 weeks' gestation, unless the biological father is known to be Rh(D)-negative. | ||
| Sensory Screening - Hearing (beyond newborn screening) | Covered annually | Ages infant through 18 years | |
| Sexually Transmitted Infections Counseling (recommends high-intensity behavioral counseling to prevent STIs for all active adolescents and for adults at increased risk for STIs) | 1 Annually | None | |
| Syphilis Screening | 1 per year Persons at increased risk and 1 per year Pregnant | None | |
| Tobacco Cessation | 1 Annually | None | |
| Tuberculosis Screening for persons at higher risk | 1 annually | All ages | |
| Vaccines Recommended by the Centers for Disease Control, Diphtheria, Tetanus, Pertussis, Measles, Mumps, Rubella, Haemophilus Influenzas Type B, Hepatitis A , Hepatitis B, Influenza, Pneumococcal, Meningococcal, Human Papillomavirus (HPV), Inactivated Poliovirus, Rotavirus, Varicella, Tetanus-Diphtheria /Tetanus-Diphtheria Acellular Pertussis, Herpes Zoster (Shingles), Adult and Child & Adolescent Immunization Schedules (for persons aged 0-6 years, 7-18 years, and "catch-up schedule") Refer to the CDCs posted schedule of immunizations http://www.cdc.gov/vaccines/schedules/index.html | N/A | N/A | |
| Visual Acuity Screening | 1 annually | Up to Age 18 | |
| Wellness Exams Include the following service when applicable: - Developmental Surveillance - History and assessment of the physical state (height, weight, BP (blood pressure), BMI (body mass index)) - Screening for congenital hypothyroidism (In newborns) - Screening and counseling for interpersonal and domestic violence The USPSTF recommends that clinicians screen for intimate partner violence (IPV) in women of reproductive age and provide or refer women who screen positive to ongoing support services - UV light exposure counseling for persons age 6 months to 24 years | Follows Pediatric Guidelines for ages 3 and under for ages 4 and older is 1 annually and for age 11 and older is 1 annually with availability to see OBGYN for preventive care. | See Frequency Covered at Preventive Benefit for details | |
