Preventive Care Coverage

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1 Preventive Care Coverage Benefits designed to protect your health BridgeSpanHealth.com Review Coverage»

2 To find out if you re eligible for preventive coverage, call the Member Services number on the back of your member ID card or go to the Contact Us link at BridgeSpanHealth.com

3 Your Preventive Care Benefits What s covered? Wondering what preventive care services your plan covers? There are lots of services available, and you may not be aware of all the tests and screenings you may need. This brochure lists what s covered at 100%, who should seek them and when. First, who s eligible? Anyone on an active BridgeSpan policy has coverage for these services. And what s covered? This brochure lists services and supplies that we cover, including limitations (how many visits per year, what kind of device, etc.). This information can change. BridgeSpan follows government guidelines to determine which preventive services we cover. 1 These guidelines are updated from time to time to reflect medical advances. New guidelines will be implemented within one year of the recommendation s publication. Also, limits on services can be revised. So it s important to check your coverage before getting preventive care. You can learn more about these services, including recommended child and adolescent immunization schedules, at healthcare.gov. How much will you pay for these services? You pay nothing for the services listed. That means you don t have to meet your deductible first, and you won t owe a copay or coinsurance. You may owe a deductible, coinsurance and/or copay when you see outof-network providers. Also, if your doctor provides preventive services that are outside the government guidelines, you may have an out-of-pocket expense. 1. These scientifically supported guidelines are created by the United States Preventive Services Task Force (USPSTF), Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).

4 For Men Preventive care services for What age (and when) What is covered Abdominal aortic aneurysm (weak area or bulge in the aorta, the body's main artery) 65+ and have ever smoked One-time screening Alcohol misuse 18+ and behavioral counseling Anemia (low iron in your blood) Up to 21 Blood pressure 18+ Cholesterol 35+, also ages if you are at high risk for heart disease Colorectal cancer (colon cancer) 50+ One sigmoidoscopy screening every 5 years, one colonoscopy screening every 10 years and a fecal occult blood test (a test for blood in your stool) every year Depression during wellness exams Diabetes (type 2) Diet behavioral counseling Gonorrhea (sexually transmitted disease/sexually transmitted infection) with sustained high blood pressure if you have hyperlipidemia (your blood is high in fats and lipids) and other risk factors Up to 21 Counseling about diet changes to help or prevent health problems Heart (cardiovascular) disease and prevention 18+ and overweight or obese Counseling to promote healthy eating and exercise to prevent heart disease Hepatitis B who are at high risk Hepatitis C if at high risk; everyone born between 1945 and 1965 ; one-time screening also if you were born between 1945 and 1965 and are not at high risk HIV 15 65, or if 65+ and at high risk Lead screening (testing for poisoning caused by exposure to lead) Lung cancer screening Up to , have a smoking history of 30 packs a year and currently smoke or have quit within the last 15 years Annual screening for lung cancer (requires pre-authorization and must meet guidelines for medical necessity) Obesity 6+, and counseling if you re diagnosed obese Prevention of falls Sexually transmitted disease/ Sexually transmitted infection (STD/ STI) 65+, living independently and at high risk for falls Physical therapy Counseling during wellness exams Skin cancer Counseling to prevent skin cancer Syphilis (sexually transmitted disease/sexually transmitted infection) Up to age 21; 21+ if at high risk Tobacco use Counseling and treatments (but not programs or classes). See also Tobacco use below under Prescription drugs.

5 For Men Continued s (shots) Ask your doctor how often to get these Diphtheria, pertussis (whooping cough), tetanus (DPT) What age (and when) What is covered Hepatitis A Hepatitis B Herpes zoster (shingles) 60+ Human papillomavirus (HPV, genital warts) Up to 27 Influenza (flu) Measles, mumps, rubella (MMR) Meningococcal (meningitis) Pneumococcal (pneumonia) Varicella (chicken pox) Prescription drugs What age (and when) What is covered Only the prescription drugs listed below are covered under preventive care benefits. Get the most value by using our preferred medications list. You can find it at Aspirin use for the prevention of heart (cardiovascular) disease Aspirin Tobacco use Over-the-counter drugs on the Tobacco Cessation Coverage list on Vitamin D supplements 65+, living independently and at increased risk for falls Vitamin D supplements Wellness exams What age (and when) What is covered Annual physical exams 18+ Exam

6 For Women Preventive care service What age (and when) What is covered Alcohol misuse 18+ and behavioral counseling Anemia (low iron in your blood) Up to 21 Birth control (contraceptive) education and training Birth control (contraceptive) methods and devices: cervical caps, IUDs, shots (injectables) and diaphragms Education and training on birth control methods (the U.S. Food and Drug Administration) Blood pressure 18+ Breast cancer 40+ or at high risk Mammograms (excludes 3-D) Breast cancer chemoprevention (breast cancer prevention) at high risk Counseling Breastfeeding equipment Manual and electric breastfeeding pumps that you buy or rent from a licensed provider (but not hospital-grade pumps) Breastfeeding lactation support and counseling Breastfeeding support and counseling when you see a licensed provider Breastfeeding supplies Initial breastfeeding supplies that come with a breastfeeding pump Cervical cancer (Pap test) if you re sexually active Chlamydia (sexually transmitted disease) Cholesterol 45+, or and at high risk for heart disease Colorectal cancer (colon cancer) 50+ One sigmoidoscopy screening every 5 years, one colonoscopy screening every 10 years and a fecal occult blood test (a test for blood in your stool) every year Contraceptives and contraceptive education and training See Birth control Depression during wellness exams Diabetes (type 2) Diet behavior counseling Genetic risk assessment and BRCA (breast cancer susceptibility) mutation counseling and testing Gonorrhea (sexually transmitted disease/sexually transmitted infection) screening Heart (cardiovascular) disease and prevention with high blood pressure if you have hyperlipidemia (your blood is high in fats and lipids) and other risk factors if you have a family risk of breast, ovarian, tubal and peritoneal cancer Counseling about diet changes to help or prevent health problems Risk assessment; also BRCA counseling and testing (requires pre-authorization and must meet guidelines for medical necessity) 18+ and overweight or obese Counseling to promote healthy eating and exercise to prevent heart disease Hepatitis B if at high risk Hepatitis C if at high risk; everyone born between 1945 and 1965 ; one-time screening also if you were born between 1945 and 1965 and are not at high risk

7 For Women Continued Preventive care service What age (and when) What is covered HIV HPV (human papillomavirus, genital warts) Interpersonal and domestic violence (physical, sexual or emotional abuse) Lead screening (testing for poisoning caused by exposure to lead) Lung cancer screening 15 65, or 65+ and at increased risk 30+ every 3 years Up to , have a smoking history of 30 packs a year and currently smoke or quit within the last 15 years and counseling during wellness exams Annual screening for lung cancer (requires pre-authorization and must meet guidelines for medical necessity) Obesity 6+, and counseling if you re diagnosed obese Osteoporosis (thinning bones) 65+ and all ages if at risk Prevention of falls Sexually transmitted disease/sexually transmitted infection (STD/STI) 65+, living independently and at high risk for falls Physical therapy Counseling during wellness exams Skin cancer Counseling to prevent skin cancer Sterilization (permanent form of birth control) Syphilis (sexually transmitted disease/sexually transmitted infection) Up to age 21; 21+ if at increased risk Sterilization Tobacco use Counseling and treatments (but not programs or classes). See also Tobacco use below under Prescription drugs. s (shots) Ask your doctor how often to get these What age (and when) What is covered Diphtheria, pertussis (whooping cough), tetanus (DPT) Hepatitis A Hepatitis B Herpes zoster (shingles) 60+ Human papillomavirus (HPV, genital warts) Up to 27 Influenza (flu) Measles, mumps, rubella (MMR) Meningococcal (meningitis) Pneumococcal (pneumonia) Varicella (chicken pox)

8 For Women Continued Prescription drugs What age (and when) What is covered Only the prescription drugs listed below are covered under your preventive care benefits. Birth control coverage: Your benefits cover generic options for all FDA-approved birth control methods at no cost to you. When there is no generic available, you can get a brand-name at no cost as long as it is on our formulary (list of covered drugs). If a generic becomes available, the formulary brand-name contraceptive will no longer be included. However if your doctor thinks that our covered birth control is not right for you, you can request an exception by calling Member Services at the number listed on the back of your member ID card. Learn more and see our formulary at Aspirin use for the prevention of heart (cardiovascular) disease Aspirin Breast cancer medications Birth control shots (contraceptive injectables) 35+ and without breast cancer symptoms Medications that reduce your risk of breast cancer (see the list of covered birth control shots on Birth control pills (see the list of covered oral contraceptives on Birth control diaphragms, vaginal rings, birth control patches, spermicides, female condoms and birth control sponges (contraceptive topical products) (see the covered contraceptives list on Contraceptives and contraceptive education and training See Birth control Emergency birth control (contraceptive) products (see the list of covered emergency contraceptives on Tobacco use Over-the-counter drugs on the Tobacco Cessation Coverage list on Vitamin D supplements 65+, living independently and at risk for falls Vitamin D supplements Wellness exams What age (and when) What is covered Annual physical exams 18+ Exam

9 For Pregnant Women Preventive care service When What is covered Anemia (iron deficiency) When pregnant Breastfeeding equipment Breastfeeding lactation support and counseling Breastfeeding supplies Diabetes gestational (diabetes that develops during pregnancy) When pregnant and post-delivery When pregnant and post-delivery When pregnant and post-delivery After 24 weeks of pregnancy and at the first prenatal visit (pregnancy checkup) if at high risk for diabetes Manual and electric breastfeeding pumps that you buy or rent from a licensed provider (but not hospital-grade pumps) Breastfeeding support and counseling when you see a licensed provider Initial breastfeeding supplies that come with a breastfeeding pump Hepatitis B When pregnant HIV Syphilis (sexually transmitted disease/ sexually transmitted infection) When pregnant, including if you ve never been tested or if you don t know if you have HIV When pregnant Tobacco use When pregnant Counseling and treatments (but not programs or classes) Urinary tract infection (bacteriuria) When pregnant and showing no symptoms Prescription drugs When What is covered Only prescription drugs listed below are covered under your preventive care benefits. Get the most value by using drugs on our preferred medications list (also called the formulary). You can find it at Aspirin use (low-dose) for the prevention of preeclampsia (high blood pressure during pregnancy) Past 12 weeks of pregnancy and at high risk for preeclampsia Low-dose aspirin Folic acid supplements When planning pregnancy Folic acid supplements

10 For Children Preventive care service What age (and when) What is covered Anemia (iron deficiency) Up to 21 Birth control (contraceptive) education and training Birth control (contraceptive) methods and devices: implants, cervical caps, IUDs, shots (injectables) and diaphragms Congenital hypothyroidism (a form of thyroid disease) Contraceptives and contraceptive education and training Newborns Education and training on birth control methods See Birth control Dental (oral) health Preschool age children Risk assessment Depression screening during wellness exams Fluoride treatment Gonorrhea medication (gonorrhea, a sexually transmitted disease, can be passed from mother to baby during birth) Gonorrhea (sexually transmitted disease/sexually transmitted infection) screening Up to age 5, starting when the first tooth appears Newborns Boys up to 21 and girls of all ages Fluoride treatment by a dentist Preventive medication for the eyes Hearing Up to 1 One screening Hepatitis B if at risk for infection Hepatitis C if at risk for infection HIV Lead screening (testing for poisoning caused by exposure to lead) Metabolic screening (the heel prick test for rare but serious conditions) 15 18, and those younger who are at risk Up to 21 Up to 2 months Obesity 6+, and counseling if you re diagnosed obese Phenylketonuria (PKU, a birth defect that causes an amino acid called phenylalanine to build up in the body) Sexually transmitted disease (STD/STI) Newborns for genetic disorders Counseling during wellness exams Sickle cell (a serious blood disease) Up to 1 Skin cancer Counseling to help prevent skin cancer Syphilis (sexually transmitted disease/sexually transmitted infection) Up to 21 Tobacco use Counseling and treatments (but not programs or classes) Tuberculosis (a potentially serious disease of the lungs) Up to 21 Tuberculosis skin tests Vision (eye exam) 3 5 Vision screening

11 For Children Continued Immunization vaccines (shots) Ask your doctor how often to get these Diphtheria, pertussis (whooping cough), tetanus (DPT) Haemophilus influenzae type b (Hib; a bacterial disease that can cause meningitis) What age (and when) What is covered Hepatitis A Hepatitis B Human papillomavirus (HPV, genital warts) Up to 27 Inactivated poliovirus (polio) Influenza (flu) Measles, mumps, rubella (MMR) Meningococcal (meningitis) Pneumococcal (pneumonia) Rotavirus (severe diarrhea) Varicella (chicken pox) Prescription drugs What age (and when) What is covered Only the prescription drugs listed below are covered under your preventive care benefits. Birth control coverage: Your benefits cover generic options for all FDA-approved birth control methods at no cost to you. When there is no generic available, you can get a brand-name at no cost as long as it is on our formulary (list of covered drugs). If a generic becomes available, the formulary brand-name contraceptive will no longer be included. However if your doctor thinks that our covered birth control is not right for you, you can request an exception by calling Member Services at the number listed on the back of your member ID card. Learn more and see our formulary at Birth control shots (contraceptive injectables) (see the list of covered birth control shots on Birth control pills (see the list of covered oral contraceptives on Birth control diaphragms, vaginal rings, birth control patches, spermicides, female condoms and birth control sponges (contraceptive topical products) Emergency birth control (contraceptive) products (see the covered contraceptives list on (see the list of covered emergency contraceptives on Fluoride supplements 6 months up to 6 years Supplements for children who don t get enough fluoride Iron supplements 6 12 months and at increased risk Drops Wellness exams What age (and when) What is covered Well-child exams Up to 18 Wellness exams

12 Questions? Have questions? Call the Member Services number on the back of your member ID card or go to the Contact Us link at BridgeSpanHealth.com wa/ BridgeSpan Health Company

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