Common use of Preventive Care Services Clause in Contracts

Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services, inclusive of current recommendations for breast cancer, that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note that recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography and prevention issued in or around November 2009 are not considered to be current. • Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. • Prostate cancer screening including digital rectal exams and prostate-specific antigen (PSA) blood tests for: ▪ Male Covered Persons who are between the ages of 40 and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancer. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a voluntary basis; and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessment. Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxxx or the telephone number on your ID card. If more than one breast pump can meet your needs, Benefits are available only for the most cost-effective pump. We will determine the following: • Which pump is the most cost-effective. • Whether the pump should be purchased or rented (and the duration of any rental). • Timing of purchase or rental.

Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services, inclusive of current recommendations for breast cancer, services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note Benefits for colorectal cancer screenings that recommendations do not have in effect a rating of the United States Preventive Services Task Force regarding breast “A” or “B” are described under Scopic Procedures – Outpatient Diagnostic and Therapeutic, including coverage for colorectal cancer screening, mammography examination and prevention issued in or around November 2009 are not considered to be currentlaboratory tests for cancer. • Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. • Prostate cancer screening Contraceptive devices, including digital rectal exams the insertion or removal of, and prostate-specific antigen (PSA) blood tests for: ▪ Male Covered Persons who are between any Medically Necessary consultations, examinations, or procedures associated with, the ages use of 40 intrauterine devices, diaphragms, injectable contraceptives, and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancerimplanted hormonal contraceptives. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a include voluntary basis; female sterilization and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessmentassociated anesthesia. Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxxx or the telephone number on your ID card. If more than one breast pump can meet your needs, Benefits are available only for the most cost-cost- effective pump. We will determine the following: • Which pump is the most cost-effective. • Whether the pump should be purchased or rented (and the duration of any rental). • Timing of purchase or rental.. Benefits include: • Bone mass measurements. Benefits for bone mass measurement will be provided for a qualified individual for scientifically proven and approved bone mass measurement for the diagnosis and evaluation of osteoporosis or low bone mass. A second bone mass measurement may be provided if at least 23 months has elapsed since the last bone mass measurement was performed. SAMPLE When Medically Necessary, benefits for a follow up bone mass measurement will be provided more frequently than every 23 months as a Covered Health Care Service for which benefits are available under the applicable medical/surgical Covered Health Care Service categories in this Policy. Medically Necessary conditions include but are not limited to: ♦ Monitoring beneficiaries on long-term glucocorticoid therapy of more than three months. ♦ Central bone mass measurement to determine the effectiveness of adding an additional treatment regimen for a qualified individual with proven low bone mass, provided the measurement is performed 12 to 18 months from the start date of the additional regiment. • Cervical cancer screening for the early detection of cervical cancer in accordance with the most recent published American Cancer Society guidelines or guidelines adopted by the North Carolina Advisory Committee on Cancer Coordination and Control including: ♦ Pap smears. ♦ Liquid-based cytology. ♦ Human papilloma virus (HPV) detection method for woman with equivocal findings on cervical cytologic analysis that are subject to the approval of and have been approved by the United States Food and Drug Administration. • Mammography screening. Benefits for screening mammography include: ♦ One or more mammograms a year, as recommended by a Physician for any woman who is at risk for breast cancer. ♦ One baseline mammogram age 35 - 39 years of age. ♦ A mammogram every other year for age 40 - 49 years of age. ♦ A mammogram every year for age 50 or older. • Newborn hearing screening ordered by the attending Physician. • One routine prostate specific antigen (PSA) test, or an equivalent serological test for a male per calendar year, and for additional PSA tests, if recommended by a Physician. • Ovarian cancer surveillance tests for women age 25 and older who are at risk for ovarian cancer. For purposes of this Benefit, the following definitions apply:

Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services, inclusive of current recommendations for breast cancer, that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note that recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography and prevention issued in or around November 2009 are not considered to be current. • Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. SAMPLE • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. • Prostate cancer screening including digital rectal exams and prostate-specific antigen (PSA) blood tests for: ▪ Male Covered Persons who are between the ages of 40 and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancer. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a voluntary basis; and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessment. Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxxx or the telephone number on your ID card. If more than one breast pump can meet your needs, Benefits are available only for the most cost-effective pump. We will determine the following: • Which pump is the most cost-effective. • Whether the pump should be purchased or rented (and the duration of any rental). • Timing of purchase or rental.

Preventive Care Services. Preventive care services provided on an outpatient basis at a Physician's office, an Alternate Facility or a Hospital encompass medical services that have been demonstrated by clinical evidence to be safe and effective in either the early detection of disease or in the prevention of disease, have been proven to have a beneficial effect on health outcomes and include the following as required under applicable law: • Evidence-based items or services, inclusive of current recommendations for breast cancer, services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force. Note that recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography and prevention issued in or around November 2009 are not considered to be current. • Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. • With respect to women, such additional preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services AdministrationAdministration as well as contraceptives that are Medically Necessary and FDA approved. • Prostate cancer screening Contraceptive devices, including digital rectal exams the insertion or removal of, and prostate-specific antigen (PSA) blood tests for: ▪ Male Covered Persons who are between any Medically Necessary consultations, examinations, or procedures associated with, the ages use of 40 intrauterine devices, diaphragms, injectable contraceptives, and 75; or ▪ When used for the purpose of guiding patient management in monitoring the response to prostate cancer treatment; or ▪ When used for staging in determining the need for a bone scan in patients with prostate cancer; or ▪ When used for Covered Persons who are at high risk for prostate cancerimplanted hormonal contraceptives. • Wellness Benefits will be provided for: ▪ A health risk assessment that is completed by a Covered Person on a include voluntary basis; female sterilization and ▪ Written feedback to the individual who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessmentassociated anesthesia. Benefits defined under the Health Resources and Services Administration (HRSA) requirement include one breast pump per Pregnancy in conjunction with childbirth. Breast pumps must be ordered by or provided by a Physician. You can find more information on how to access Benefits for breast pumps by contacting us at xxx.xxxxx.xxx/xxxxxxxx or the telephone number on your ID card. If more than one breast pump can meet your needs, Benefits are available only for the most cost-effective pump. We will determine the following: • Which pump is the most cost-effective. • Whether the pump should be purchased or rented (and the duration of any rental). • Timing of purchase or rental. Benefits include: • Baseline breast cancer screening mammography for women over age 35 and under age 40. • Annual breast cancer screening mammography for women age 40 and older. Breast cancer screening mammography is a standard 2-view per breast, low-dose radiographic examination of the breasts, using equipment designed and dedicated specifically for mammography, in order to detect unsuspected breast cancer. Breast cancer screenings that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force are described under Preventive Care Services. For further information regarding a preventive health services listing, please refer to the U.S. Preventive Services Task Force website at xxxx://xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx.