53 Preventive care includes screenings and other services for adults and children. All recommended preventive services will be covered as required by the Affordable Care Act (ACA) and applicable state law. This means many preventive care services are covered with no Deductible, Copayments or Coinsurance when you use a Participating Provider. Certain benefits for Members who have current symptoms or a diagnosed health problem may be covered under the “Diagnostic Services” benefit instead of this benefit, if the coverage does not fall within the state or ACA-recommended preventive services. Covered Services fall under the following broad groups: 1. Services with an “A” or “B” rating from the United States Preventive Services Task Force. Examples include screenings for: a. Breast cancer, b. Cervical cancer, c. Colorectal cancer - This includes the preventive colonoscopy, anesthesia, polyp removal and pathology tests in connection with the preventive screening. It also includes a preventive screening following a positive non-invasive stool-based screening test or following a positive direct visualization test (i.e., flexible sigmoidoscopy, CT colonography), d. High blood pressure, e. Type 2 Diabetes Mellitus, f. Cholesterol, g. Child and adult obesity. 2. Immunizations for children, adolescents, and adults recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; 3. Preventive care and screenings for infants, children, and adolescents as listed in the guidelines supported by the Health Resources and Services Administration; 4. Preventive care and screening for women as listed in the guidelines supported by the Health Resources and Services Administration, including: a. Women’s contraceptives, sterilization treatments, and counseling. Coverage includes contraceptive devices such as diaphragms. Benefits are not available, however, for intrauterine devices (IUDs) or implants. b. Breastfeeding support, supplies, and counseling. Benefits for breast pumps are limited to one pump per pregnancy . c. Gestational diabetes screening. 5. Preventive care services for smoking cessation and tobacco cessation for Members age 18 and older as recommended by the United States Preventive Services Task Force including counseling. 6. Prescription Drugs and OTC items identified as an A or B recommendation by the United States Preventive Services Task Force when prescribed by a Provider including: a. Aspirin b. Folic acid supplement c. Bowel preparations d. FDA-approved preexposure prophylaxis (PrEP), related services and monitoring including follow- up HIV testing and additional testing to monitor the effects of the PrEP medications.
2025 Retiree Indemnity Plan Booklet Page 53 Page 55