Preventive Health Care Services. We cover the following preventive Services without any Cost Sharing requirements, such as Deductibles, Copayment amounts or Coinsurance amounts to any Member receiving any of the following benefits for Services from Plan Providers: 1. Evidenced-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force, except that the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention of breast cancer shall be considered the most current other than those issued in or around November 2009 (To see an updated list of the USPSTF “A” or “B” rated services. Visit xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx); 2. 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 the individual involved (Visit the Advisory Committee on Immunization Practices at xxxx://xxx.xxx.xxx/vaccines/acip/index.html); 3. 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. Visit HRSA at xxxx://xxxx.xxxx.xxx); and 4. With respect to women, such additional preventive care and screenings, not described in paragraph 1 above, as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. Visit HRSA at xxxx://xxxx.xxxx.xxx). The Health Plan shall update new recommendations to the preventive benefits listed above at the schedule established by the Secretary of Health and Human Services. We cover medically appropriate preventive health care Services based on your age, sex, or other factors, as determined by your primary care Plan Physician in accordance with national preventive health care standards. These Services include the exam, screening tests and interpretation for: 1. Preventive care exams, including: a. Routine physical examinations and health screening tests appropriate to your age and sex; b. Well-woman examinations; and c. Well child care examinations. 2. Routine and necessary immunizations (travel immunizations are not preventive and are covered under Outpatient Services in this section) for children and adults in accordance with Plan guidelines. Childhood immunizations include diphtheria, pertussis, tetanus, polio, hepatitis B, measles, mumps, rubella and other immunizations as may be prescribed by the Commissioner of Health; 3. An annual pap smear, including coverage for any FDA-approved gynecologic cytology screening technology; 4. Breast cancer screening in accordance with the latest screening guidelines issued by the American Cancer Society. The Deductible, if any, will not apply to this provision; 5. Bone mass measurement to determine risk for osteoporosis; 6. Prostate Cancer screening including diagnostic examinations, digital rectal examinations, and prostate antigen (PSA) tests provided to men who are age 40 or older; 7. Colorectal cancer screening in accordance with the latest screening guidelines issued by the American Cancer Society; 8. Cholesterol test (lipid profile); 9. Diabetes screening (fasting blood glucose test); 10. Sexually Transmitted Disease (STD) tests (including chlamydia, gonorrhea, syphilis and HPS), subject to the following: a. Annual chlamydia screening is covered for (1) women under age 20, if they are sexually active; and (2) women age 20 or older; and men of any age, who have multiple risk factors, which include: (1) a prior history of sexually transmitted diseases; (2) new or multiple sex partners, (3) inconsistent use of barrier contraceptives or (4) cervical ectopy; b. Human Papillomavirus Screening (HPS) at the intervals recommended for cervical cytology screening by the American College of Obstetricians and Gynecologists. 11. HIV tests; 12. TB tests; 13. Hearing loss screenings for newborns provided by a hospital prior to discharge; and 14. Associated preventive care radiological and lab tests not listed above.
Appears in 2 contracts
Samples: Group Agreement, Group Agreement
Preventive Health Care Services. We In addition to any other preventive benefits described in the group contract or certificate, the Health Plan shall cover the following preventive Services without and shall not impose any Cost Sharing cost-sharing requirements, such as Deductibles, Copayment amounts amounts, or Coinsurance amounts to any Member receiving any of the following benefits for Services from Plan Providers:
: 1. Evidenced-based items or services Services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force, except that the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention of breast cancer shall be considered the most current other than those issued in or around November 2009 2009. (To see an updated list of the USPSTF “A” or “B” rated services. Visit xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxxUSPSTF Services, visit: xxx.xxxxxxxxxxxxXxxxxxxxxxxxxxxxx.xxx);
; 2. 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 the individual involved involved. (Visit the Advisory Committee on Immunization Practices at at: xxxx://xxx.xxx.xxx/vaccines/acip/index.html);
; 3. 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. (Visit HRSA at at: xxxx://xxxx.xxxx.xxx); and
and 4. With respect to women, such additional preventive care and screenings, not described in paragraph 1 above, as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. Administration (Visit HRSA at xxxx://xxxx.xxxx.xxx), except for those Services excluded in Exclusions. The Health Plan shall update new recommendations to the preventive benefits listed above at the schedule established by the Secretary of Health and Human Services. We cover medically appropriate preventive health care Care Services based on your age, sex, sex or other factors, as determined by your primary care Primary Care Plan Physician in accordance with national preventive health care standards. These Services include the exam, screening tests and interpretation for:
: 1. Preventive care exams, including:
: a. Routine physical examinations and health screening tests appropriate to your age and sex;
; b. Well-woman examinations, including visits to obtain necessary preventive care, and preconception care and prenatal care; and
and c. Well child care childcare examinations.
; 2. Routine and necessary immunizations (travel immunizations are not preventive and are covered under Outpatient Services in this sectionCare) for children and adults in accordance with Plan guidelines. Childhood immunizations include diphtheria, pertussis, tetanus, polio, hepatitis B, measles, mumps, rubella and other immunizations as may be prescribed by the Commissioner of Health;
; 3. An annual pap smear, including coverage for any FDA-approved gynecologic cytology screening technology;
; 4. Breast cancer Low dose screening in accordance with the latest screening guidelines issued by the American Cancer Society. The Deductiblemammograms, if any, will not apply to this provision;
5. Bone mass measurement including 3-D mammograms to determine risk the presence of breast disease is covered as follows: a. One mammogram for osteoporosis;
6. Prostate Cancer screening including diagnostic examinations, digital rectal examinations, and prostate antigen (PSA) tests provided to men who are persons age 35 through 39; b. One mammogram biennially for persons age 40 or older;
7. Colorectal cancer screening in accordance with the latest screening guidelines issued by the American Cancer Society;
8. Cholesterol test (lipid profile);
9. Diabetes screening (fasting blood glucose test);
10. Sexually Transmitted Disease (STD) tests (including chlamydia, gonorrhea, syphilis and HPS), subject to the following:
a. Annual chlamydia screening is covered for (1) women under age 20, if they are sexually activethrough 49; and (2) women age 20 c. One mammogram annually for person 50 or older; and men 5. Adjuvant breast cancer screening, including magnetic resonance imaging (MRI), ultrasound, screening, or molecular breast imaging of any agethe breast, who have multiple if: a. A mammogram demonstrates a Class C or Class D breast density classification; or b. A woman is believed to be at an increased risk factors, which include: (1) a for cancer due to family history or prior personal history of sexually transmitted diseases; (2) new breast cancer, positive genetic testing, or multiple sex partners, (3) inconsistent use other indications of barrier contraceptives or (4) cervical ectopy;
b. Human Papillomavirus Screening (HPS) at the intervals recommended an increased risk for cervical cytology screening by the American College of Obstetricians and Gynecologists.
11. HIV tests;
12. TB tests;
13. Hearing loss screenings for newborns provided cancer as determined by a hospital prior to discharge; and
14. Associated preventive care radiological and lab tests not listed abovewoman’s physician or advanced practice registered nurse.
Appears in 2 contracts
Samples: Group Agreement, Group Agreement
Preventive Health Care Services. We In addition to any other preventive benefits described in the group contract or certificate, the Health Plan shall cover the following preventive Services without and shall not impose any Cost Sharing cost-sharing requirements, such as Deductibles, Copayment amounts or Coinsurance amounts to any Member receiving any of the following benefits for Services from Plan Providers:
: 1. Evidenced-based items or services Services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force, except that the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention of breast cancer shall be considered the most current other than those issued in or around November 2009 2009. (To see an updated list of the USPSTF “A” or “B” rated services. Visit xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxxUSPSTF Services, visit: www.uspreventiveServicestaskforce.org);
; 2. 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 the individual involved involved. (Visit the Advisory Committee on Immunization Practices at xxxx://xxx.xxx.xxx/vaccines/acip/index.htmlat: http://www.cdc.gov/vaccines/acip/index.html);
; 3. 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. (Visit HRSA at xxxx://xxxx.xxxx.xxxat: http://mchb.hrsa.gov); and
and 4. With respect to women, such additional preventive care and screenings, not described in paragraph 1 above, as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. Administration (Visit HRSA at xxxx://xxxx.xxxx.xxxhttp://mchb.hrsa.gov), except for those Services excluded in Exclusions. The Health Plan shall update new recommendations to the preventive benefits listed above at the schedule established by the Secretary of Health and Human Services. We cover medically appropriate preventive health care Care Services based on your age, sex, sex or other factors, as determined by your primary care Primary Care Plan Physician in accordance with national preventive health care standards. These Services include the exam, screening tests and interpretation for:
: 1. Preventive care exams, including:
: a. Routine physical examinations and health screening tests appropriate to your age and sex;
; b. Well-woman examinations; and
and c. Well child care examinations.
; 2. Routine and necessary immunizations (travel immunizations are not preventive and are covered under Outpatient Services in this sectionCare) for children and adults in accordance with Plan guidelines. Childhood immunizations include diphtheria, pertussis, tetanus, polio, hepatitis B, measles, mumps, rubella and other immunizations as may be prescribed by the Commissioner of Health;
; 3. An annual pap smear, including coverage for any FDA-approved gynecologic cytology screening technology;
; 4. Breast cancer Low dose screening in accordance with mammograms to determine the latest screening guidelines issued by the American Cancer Society. The Deductible, if any, will not apply to this provision;
presence of breast disease is covered as follows: a. One mammogram for persons age 35 through 39; b. One mammogram biennially for persons age 40 through 49; and c. One mammogram annually for person 50 or older; 5. Bone mass measurement to determine risk for osteoporosis;
6. Prostate Cancer screening including diagnostic examinations, digital rectal examinations, and prostate antigen (PSA) tests provided to men who are age 40 or older;
7. Colorectal cancer screening in accordance with the latest screening guidelines issued by the American Cancer Society;
8. Cholesterol test (lipid profile);
9. Diabetes screening (fasting blood glucose test);
10. Sexually Transmitted Disease (STD) tests (including chlamydia, gonorrhea, syphilis and HPS), subject to the following:
a. Annual chlamydia screening is covered for (1) women under age 20, if they are sexually active; and (2) women age 20 or older; and men of any age, who have multiple risk factors, which include: (1) a prior history of sexually transmitted diseases; (2) new or multiple sex partners, (3) inconsistent use of barrier contraceptives or (4) cervical ectopy;
b. Human Papillomavirus Screening (HPS) at the intervals recommended for cervical cytology screening by the American College of Obstetricians and Gynecologists.
11. HIV tests;
12. TB tests;
13. Hearing loss screenings for newborns provided by a hospital prior to discharge; and
14. Associated preventive care radiological and lab tests not listed above.
Appears in 1 contract
Samples: Group Agreement
