Using Your Preventive Benefits

May 15, 2019

Leona Long

Your Premera Blue Cross Blue Shield of Alaska Plan pays in-network preventive services in full. You'll get the most value from these benefits by choosing a doctor in your plan’s network. Getting timely preventive care is one way to detect potential health issues before they become serious and possibly expensive to treat.

 

So, take advantage by following these simple steps:

  1. Schedule your annual exam and vaccinations with your doctor right away!
  2. When you make your appointment, be sure to tell the scheduler that you want a preventive exam.
  3. Bring this flyerwith you to show your doctor what’s considered preventive and covered in full under your medical plan. Talk with your doctor about preventive services that are right for you.

Keep in mind

During your visit, your doctor may find a problem that needs more screening or tests to pinpoint the issue. Also, if you manage an ongoing health issue, your doctor may run further tests. Screenings and tests that diagnose or monitor your condition are not preventive services and are subject to your annual plan deductible and coinsurance. Recommended age and frequency of

preventive services vary. If you have any questions about your preventive coverage, call the customer service number on the back of your member ID card.

 

ADULTS 18 AND OLDER:

Services, screenings, and tests

  • Wellness exams for ages 18 and older; visits for routine wellness or physical exams
  • Abdominal aortic aneurysm screening for men (65 to 74) who have ever smoked; one-time screening
  • Alcoholism screening and counseling
  • Blood pressure screening
  • Breast cancer screening: screening mammography
  • Cholesterol test for adults of specific ages or those at higher risk
  • Colorectal cancer screenings starting at age 50 through age 75; sooner than age 50 for those at higher risk of colon cancer.

Colorectal screening options include:

– Home tests: Fecal occult blood (FOBT), fecal immunochemical (FIT) and stool DNA (Cologuard*)

– Doctor’s office: Sigmoidoscopy

– Outpatient hospital, ambulatory surgical center: Colonoscopy (If your doctor recommends a screening colonoscopy, costs for related services such as pre-colonoscopy consultation, anesthesia your doctor considers medically appropriate for you, removal of polyps, and pathology are included.)

  • Depression screening
  • Diabetes (Type 2) screening
  • Fall prevention for ages 65 and older
  • Healthy eating assessment and dietary counseling
  • Hepatitis B screening for those at higher risk
  • Hepatitis C screening
  • HIV (human immunodeficiency virus) infection screening for those at higher risk
    Latent tuberculosis infection screening for those at higher risk
  • Lung cancer screening for ages 55 to 80 at higher risk; prior authorization required; please contact customer service
  • Nicotine dependency screening and counseling for quitting smoking or chewing tobacc
  • Obesity screening and counseling for weight loss
  • Prostate cancer screening; prostate-specific antigen (PSA)blood test
  • Sexually transmitted infection (STI) counseling for those at higher risk
  • Syphilis testing for those at higher risk

Medications and supplements

  • Aspirin for pregnant women who are at high risk for preeclampsia or those at risk due to heart conditions between the ages of 45 and 79; over-the-counter, aspirin-only products (75–325 mg). Requires a written prescription.
  • Birth control for birth control devices and family planning; generic, single-source, and multi-source brand oral contraceptives (including emergency contraception), cervical caps, patches, diaphragms, IUDs (intrauterine device), contraceptive implants, injectable contraception, and over-the-counter birth control (for example, female condoms, sponges). Requires a written prescription.
  • Breast cancer preventive medications for those at higher risk — raloxifene, Soltamox, and tamoxifen
  • Folic acid for women who are pregnant or are considering pregnancy; over-the-counter (0.4–0.8 mg). Requires a written prescription.
  • Pre-colonoscopy cleansing preparations for those between the ages of 50 and 75; generic or single-source brands. Requires a written prescription. Fill limit of 2 every 365 days. (Over-the-counter drugs are not covered as a preventive benefit.)
  • Statins for prevention of cardiovascular diseases; generic low- to moderate-dose statins for males and females between ages of 40 to 75
  • Tobacco cessation over-the-counter, generic patches, lozenges, and gum; prescription only for bupropion (Generic Zyban), Chantix, NRT (nicotine replacement therapy) nasal spray, or NRT inhaler. Requires a written prescription. 

 

Reproductive and women’s health

  • Birth control, contraception, and family planning: visits for birth control devices and family planning; generic, single-source, and multi-source brand oral contraceptives (including emergency contraception), cervical caps, patches, diaphragms, insertion or removal of IUD (intrauterine device), contraceptive implants, injectable contraception, and over-the-counter birth control (for example: female condoms, sponges). Requires a written prescription.
  • Bone density (osteoporosis) screening
  • Breast and ovarian cancer (BRCA) genetic counseling and testing: prior authorization for testing required, please contact customer service
  • Breast cancer (chemoprevention) counseling for women at higher risk
  • Breast cancer preventive medications for those at higher risk — raloxifene, Soltamox, and tamoxifen
  • Breast cancer screening: screening mammography
  • Cervical cancer screening: Pap test
  • Chlamydia infection screening
  • Domestic violence screening and counseling
  • Gonorrhea screening for those at higher risk
  • HPV (human papillomavirus) screening
  • Sterilization for women

 

Vaccinations

  • Chicken pox (Varicella)
  • Flu (Influenza)
  • Hepatitis A
  • Hepatitis B
  • HPV (Human papillomavirus)
  • Meningitis (Meningococcal)
  • MMR (Measles, mumps, rubella)
  • Pneumonia (Pneumococcal)
  • Shingles (Herpes zoster)
  • Tdap (Tetanus, diphtheria, pertussis)

 

Pregnancy

  • Anemia screening
  • Bacteriuria urinary tract infection screening
  • Breast-feeding interventions to support and promote breast feeding before and after childbirth
  • Breast pumps and supplies (single or double styles)
  • Folic acid for women who are pregnant or are considering pregnancy; over-the-counter (0.4–0.8 mg) Requires a written prescription.
  • Gestational diabetes screening
  • Hepatitis B infection screening
  • Rh (antibody) incompatibility testing
  • Syphilis screening