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 Customer Service at (866) 403-2785.


Preventive Health Care BenefitFrequencyAge Limits
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.htmlN/AN/A
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 NecessaryAges 6 and Over
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 acidN/AN/A
Gestational Diabetes Mellitus (GDM) Screening in asymptomatic pregnant women after 24 weeks of gestation.1 per pregnancyNone
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 Women1 per year
1 per year Pregnant
None
Group B strep testing performed one time during pregnancy1 per pregnancyNone
Hemoglobinopathies Screening (for sickle cell disease in newborns)1 per lifetimeAges 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 PregnantAges 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 yearsAges 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 PregnantAges 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/AN/A
Lead Screening 1 per yearAges 7 and Under
Lung Cancer Screen (LDCT)1 per yearAges 50 - 80
Lung Cancer Screen (LDCT) Counseling1 per yearAges 50 - 80
Colorectal Cancer Screening - FOBT1 per yearAges 45-75 Routine
Ages 18-75 High Risk
Osteoporosis Screening - Bone density CT1 every two yearsAge 65 and Older unless high risk in which case is age 20 and older
Osteoporosis Screening - Bone density tests1 every two yearsAge 65 and Older unless high risk in which case is age 20 and older
PKU Screening (in newborns)1 per lifetimeAges 0 - 8 Days
Prophylactic medication for gonorrhea: newborns (ocular topical medication for all newborns against gonococcal ophthalmia neonatorum)N/AN/A
Prostate Screening 1 AnnuallyMales Ages 50 - 70
Sensory Screening - Hearing (beyond newborn screening)Covered annuallyAges 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 AnnuallyNone
Syphilis Screening1 per year Persons at increased risk and 1 per year PregnantNone
Tobacco Cessation 1 AnnuallyNone
Tuberculosis Screening for persons at higher risk 1 annuallyAll ages
Visual Acuity Screening1 annuallyUp 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 yearsFollows 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
Cervical cancer/HPV screeningWomen 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)
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 mellitus1 per year Adults
1 per year Pregnant
Ages 40 to 70 Unless pregnant then no age limit
Alcohol Substance Misuse 1 per yearNone
Anemia Screening1 per year PregnantNone
Aspirin use for the prevention of preeclampsia for women over 12 weeks gestation and who are at high risk for preeclampsiaN/AN/A
Bacteriuria Screening: using urine culture in pregnant persons.1 per year PregnantNone
BART Testing1 per lifetimeNone
Bilirubin Screening: infants with gestational age of 35 weeks or greater1 per lifetimeAges 0 - 8 Days
BRCA Counseling1 per yearNone
BRCA Testing1 per lifetimeNone
Breast Cancer Chemoprevention1 per year for visit. No limit of fills on risk-reducing medications dispensed to member with a physician order with no cost-sharingFemale 35 years or older
Breast Cancer Screening: Mammograms and Digital Breast Tomosynthesis1 per yearFemale 40 years of age or older unless considered high risk then is 39 years of age or younger
Breast Cancer Screening: MRI1 per yearFemale 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 RequirementsNone
Abdominal Aortic Aneurysm Screening1 per lifetimeMen Ages 65-75
Chlamydial Infection Screening 1 per year and 1 per year pregnantWomen 24 and Older unless pregnant in which case there is no age limit
Cholesterol Abnormalties/Lipid Disorder Screening 1 per yearSee other requirements
Colorectal Cancer Screening - Colonoscopy1 per 10 years unless high risk in which case is 1 per 2 yearsAges 45-75 - Routine
Ages 18-75 - High Risk
Colorectal Cancer Screening - CT Colonography1 per 5 yearsAges 45-75 - Routine
Ages 18-75 - High Risk
Colorectal Cancer Screening - Sigmoidoscopy1 per 5 years unless high risk in which case is 1 per 2 yearsAges 45-75 - Routine
Ages 18-75 - High Risk
Contraceptive methods and counseling N/AN/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 yearAges 12 years and above
Developmental Screening1 annuallyUp to age 18
Emotional/behavioral assessment1 per yearNone
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
Fecal DNA (Cologuard)1 per 3 yearsAges 45 - 75 - Routine
Colorectal Cancer Screening - FIT1 per yearAges 45-75 - Routine
Ages 18-75 - High Risk
Flouride Varnish1 quarterlyUp to age 5