Covered Preventive Care Services for Children
The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan. Take advantage of preventive care and stop problems before they get serious.
To be covered with no out-of-pocket costs, the service must be:
- Provided by an in-network doctor or facility (urgent care facility, outpatient clinic or ambulatory surgery center)
- Filed by your doctor as a preventive care visit
- Identified as preventive care under the Affordable Care Act (ACA)
100% covered services for children
The age and frequency listed below are general recommendations.
Talk to your doctor to find out which of these you should have based on your health.
Click on a service to see any limits or exclusions.
Infants
Anemia (Iron in the Blood)Who Should Get It: Infants to age 12 months
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Bilirubin ScreeningWho Should Get It: Newborns
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Cavity Prevention (Prevention of Dental Caries)Who Should Get It: Infants over 6 months
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Congenital Hypothyroidism ScreeningWho Should Get It: Newborns
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Critical Congenital Heart Defect ScreeningWho Should Get It: Newborns
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Hearing Loss ScreeningWho Should Get It: Newborns
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Phenylketonuria (PKU) ScreeningWho Should Get It: Newborns
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Preventive Medication for GonorrheaWho Should Get It: High-risk newborns
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Sickle Cell Disease ScreeningWho Should Get It: Newborns
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Children
Alcohol and Drug Use AssessmentWho Should Get It: From age 11
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Anticipatory GuidanceWho Should Get It: Under age 18
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Autism ScreeningWho Should Get It: 18 and 24 months
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Behavioral Counseling to Prevent Skin CancerWho Should Get It: Age 10 - 24 with fair skin
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Cavity Prevention (Prevention of Dental Caries)Who Should Get It: Children under 16
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Cholestorol Screening (Dyslipdemia)Who Should Get It: Under age 18
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Developmental ScreeningWho Should Get It: 9, 18 and 30 months
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Developmental SurveillanceWho Should Get It: Under age 18
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Hearing Screening (Beyond Newborn Screening)Who Should Get It: Under 18
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Lead ScreeningWho Should Get It: Children up to age 7
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Obesity Screening and CounselingWho Should Get It: Children age 6 and older
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Oral Health CheckWho Should Get It: Under age 18
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Psychosocial/Behavioral AssessmentWho Should Get It: Under age 18
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Tobacco Use for Children and AdolescentsWho Should Get It: School-age children and adolescents
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Tuberculin TestWho Should Get It: Under age 18
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Vision ScreeningWho Should Get It: Under age 18
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Adolescents and Teens
Anxiety ScreeningWho Should Get It: Female adolescents
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Behavioral Counseling Interventions for Healthy Weight and Weight Gain in PregnancyWho Should Get It: Pregnant adolescents
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Behavioral Counseling to Prevent Skin CancerWho Should Get It: Age 10 - 24 with fair skin
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Chlamydia ScreeningWho Should Get It: Sexually active adolescents 15 and older who are at increased risk of infection
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Contraception: Education and Contraceptive MethodsWho Should Get It: Female adolescents who are sexually active or thinking about becoming sexually active
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Depression ScreeningWho Should Get It: Children from age 12
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Gonorrhea screeningWho Should Get It: Sexually active adolescents 15 and older who are at increased risk of infection
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Hepatitis B ScreeningWho Should Get It: Adolescents at high risk of infection
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HIV Infection Prevention with Pre-exposure ProphylaxisWho Should Get It: Adolescents at high risk of acquiring HIV
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Intimate Partner Violence ScreeningWho Should Get It: Female adolescents
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Obesity Screening and CounselingWho Should Get It: Children Age 6 and Older
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Sexually Transmitted Infection (STI) / HIV Screening and Behavioral Counseling to Prevent STIsWho Should Get It: Sexually active adolescents and teens
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Syphilis ScreeningWho Should Get It: Adolescents at high risk of infection
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Tobacco Use Counseling for Children and AdolescentsWho Should Get It: School-age children and adolescents
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Well-child visitsWho Should Get It: Female adolescents
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Immunizations
Infants and Children
The following are the recommended vaccines for children that are covered with no out of pocket cost. Doses, recommended ages and recommended populations vary.
See your doctor and refer to the CDC’s posted schedule of immunizations.
- Dengue Fever
- Diphtheria, Tetanus-Acellular, Pertussis (DTap)
- Haemophilus Infuenzae Type B (Hib)
- Hepatitis A
- Hepatitis B
- Inactivated Poliovirus (IPV)
- Influenza (Flu)
- Measles, Mumps, Rubella (MMR)
- Pneumococcal
- Rotavirus
- Varicella (Chicken Pox)
Adolescents and Teens
- Human papillomavirus (HPV)
- Influenza (flu)
- Meningococcal
- Tetanus, diphtheria, acellular pertussis (Tdap)
The Affordable Care Act (ACA) has identified certain services as preventive care to be paid at 100%.
- These benefits are available for members of non-grandfathered individual health insurance plans.
- If you get benefits from your employer, you may also have these benefits. If your Summary of Benefits section of your Benefit Booklet contains PREVENTIVE CARE covered under federal law, then you have these benefits at no charge IN-NETWORK.
- These benefits are currently in effect unless otherwise noted.
- Check your Benefit Booklet for details on other preventive care benefits.
- This information is a reference tool and does not guarantee payment of any claims.
- For transgendered individuals, you have access to medically appropriate preventive services.