Preventive Care Services
for Women

Find your health benefits and coverage

Covered Preventive Care Services for Women

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)

Special information for employees of religious organizations.



100% covered services for women

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.

Cancer Screenings and Counseling

Breast Cancer Screening (Mammogram)

Who Should Get It: Women age 40 and older

  • Description: Screening for breast cancer in women over 40
  • Frequency: Every 1–2 years, with or without clinical breast examination
  • More information: Effective 6.1.17, 3D mammography screening will be a covered service.

Cervical Cancer Screening

Who Should Get It: Women age 21 - 65

  • Description: Screening for cervical cancer
  • Frequency:
    • In women age 21–29 with cervial cytology (pap test) every 3 years
    • For women age 30–65
      • A Pap test every 3 years or
      • A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or
      • hrHPV test only every 5 years

Colorectal Cancer Screenings

Who Should Get It: Age 50 - 75

  • Description: Screening for colon/colorectal cancer in adults age 50–75
  • Frequency: Using fecal blood testing (gFOBT or FIT) annually, sigmoidoscopy or CT/virtual colonography every 5 years, or colonoscopy every 10 years. These tests are available in network.
  • More information:
    • If you have a positive fecal blood test (gFOBT or FIT or Cologuard), your doctor may order a follow up colonoscopy. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs.
    • If you had a polyps removed during a previous preventive screening colonoscopy, future colonoscopies will be covered but may not be considered preventive so you may have out of pocket costs.
    • Your doctor may order a colonoscopy more frequently than every 10 years. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs.
    • Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%.
    • Certain bowel preparation medications for a screening colonoscopy are covered at 100% when prescribed by a doctor.
    • If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this ACA Copay Waiver Criteria; if you meet these criteria, they can submit this information on this fax form.
    • Barium enema is a covered service but not at 100% so you may have out of pocket costs.

Lung Cancer Screening

Who Should Get It: Age 50 - 80 and high risk due to smoking or other exposure

  • Description: Annual screening for lung cancer with low-dose Computed Tomography scan in adults ages 50 to 80 years who have a 20-pack-per-year smoking history and currently smoke or have quit within the past 15 years
  • Frequency: Annually if you qualify as high risk
  • More information: Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery

Behavioral Counseling to Prevent Skin Cancer

Who Should Get It: Age 10 - 24 with fair skin

  • Description: Counseling young adults, adolescents, children, and parents of young children about minimizing exposure to UV radiation for persons aged 6 months to 24 years with fair skin types to reduce their risk of skin cancer.
  • Frequency: May vary based on your health so ask your doctor

Additional Services for Women at High-risk for Breast Cancer

BRCA Risk Assessment and Genetic Counseling/Testing

Who Should Get It: Women who have personal or family history of breast, ovarian, tubal or peritoneal cancer or ancestry associated with breast cancer susceptibility

  • Description: Assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations with an appropriate brief familial risk assessment tool.
  • Frequency: May vary based on your health so ask your doctor. However, women with positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing.

Breast Cancer Preventive Medications

Who Should Get It: High-risk women age 35 and older without a prior diagnosis of breast cancer, ductal carcinoma in situ, or lobular carcinoma in situ

  • Description: Clinicians should offer to prescribe risk reducing medications such as tamoxifen, raloxifen or aromatase inhibitors (anastrozole) to women who are at increased risk for breast cancer and at low risk for adverse medication effects.
  • Frequency: May vary based on your health so ask your doctor
  • Exclusions: Applies to asymptomatic women aged 35 years or older without a prior diagnosis of breast cancer, ductal carcinoma in situ, or lobular carcinoma in situ; generic risk-reducing medications are covered as preventive
  • More information:For members who have swallowing problems or may have an intolerance to generic products, brand products may also be made available by completing this form and faxing it to the number on the bottom of the document.

    Disease Prevention and Heart Health

    Aspirin to Prevent Cardiovascular Disease and Colorectal Cancer in Women

    Who Should Get It: Women age 50–59 under certain conditions

    • Description: Low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.
    • Frequency: May vary based on your health so ask your doctor
    • Exclusions: Over-the-counter (OTC) aspirin (81 mg) is only covered with a prescription

      Diabetes Screening 

      Who Should Get It: Adults aged 40 to 70 who are overweight or obese; certain women after pregnancy

      • For adults aged 40-70: Screening for abnormal blood glucose as part of cardiovascular risk assessment. Clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity
        Frequency: May vary based on your health so ask your doctor
      • For women with a history of gestational diabetes who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes.
        Frequency: Initial testing 3 should ideally occur within the first year postpartum and can be conducted as early as 4 to 6 weeks postpartum.

      High Blood Pressure Screening

      Who Should Get It: Age 18 and older

      • Description: Screening for high blood pressure in adults. Obtain measurements outside of the clinical setting for diagnostic confirmation before starting treatment.
      • Frequency: May vary based on your health so ask your doctor.
      • More information: Effective January 1, 2017, blood pressure monitors will be covered at 100% for members who have an elevated blood pressure during their doctor's visit, but have not been diagnosed with high blood pressure. This will cover ambulatory blood pressure monitors and home blood pressure monitors. Home blood pressure monitors must be purchased from an in-network DME provider. To find a DME provider, use our Find a Doctor tool on BlueConnectNC.com

      Latent Tuberculosis Infection Screening 

      Who Should Get It: Age 18 and older if at increased risk

      • Description: Screening for latent tuberculosis in populations at increased risk.
      • Frequency: May vary based on your health so talk to your doctor.

      Osteoporosis (Bone Density) Screening

      Who Should Get It: Women age 65 and older, younger high-risk women

      • Description: For women 65 years and older: Screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures. For women younger than 65: screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool.
      • Frequency: May vary based on your health so ask your doctor

        Statin Use for the Primary Prevention of Cardiovascular Disease (CVD) in Adults

        Who Should Get It: Adults aged 40-75 with certain risk factors

        • Description: Initiate use of low- to moderate-dose statins in adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10% or greater. Screening for high cholesterol is also covered.
        • More Information:
          • Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). If there is a medical reason you cannot use a generic statin, your doctor should review this ACA Copay Waiver Criteria; if you meet these criteria, they can submit this information on this fax form.
          • Screening for high cholesterol is also covered at 100% every 5 years or annually for those with increased risk for CVD.

          Pregnancy and Childbirth

          Breastfeeding Support, Supplies and Counseling

          Who Should Get It: Pregnant women/women who have delivered a baby recently

          • Description: Interventions during pregnancy and after birth to promote and support breastfeeding; comprehensive lactation (breastfeeding) support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for breastfeeding equipment (see Exclusions)
          • Frequency: May vary based on your health so ask your doctor
          • More information: Counseling covered at 100% through in-network providers (i.e., OB/GYNs, midwives, facilities)
            • Certain breast pumps for pregnant and post-partum women
              • One manual or electric breast pump purchase per delivery is covered
              • Benefit available during third trimester (starting 11.1.16) or after member has delivered the baby
              • Breast pumps come with certain supplies, such as tubing, shields and bottles
              • Additional replacement supplies are not covered with the initial breast pump purchase. Replacement supplies are only covered after the breast pump has been purchased and are limited to 2 of each supply per year.
              • Breast pumps must be purchased from participating Durable Medical Equipment (DME) vendors
          • Exclusions: All other supplies are excluded (i.e., creams, nursing bras, milk storage bags); hospital-grade breast pumps are excluded and not covered

            Gestational Diabetes Mellitus Screening

            Who Should Get It: Pregnant Women

            • Description: For asymptomatic pregnant women identified to be at high risk for diabetes
            • Frequency: Twice, any time after 24 weeks’ gestation (ideally 24–28 weeks) and at the first prenatal visit

            HIV Screening

            Who Should Get It: Pregnant Women

            • Description: Screen all pregnant women for HIV including those how present in labor who are untested and whose HIV status is unknown
            • Frequency: May vary based on your health so talk to your doctor

            Low-dose Aspirin for High-risk Pregnant Women

            Who Should Get It: Pregnant women at high risk for Preeclampsia

            • Description: Use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks’ gestation
            • Frequency: May vary based on your health so ask your doctor

            Maternal Depression Screening and Prevention of Perinatal Depression

            Who Should Get It: Pregnant and postpartum women

            • Description:
              • Screening for depression in postpartum women.
              • Provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions.
            • Frequency for screening postpartum women: At 1, 2, 4, and 6-month infant visits

            Preeclampsia Screening

            Who Should Get It: Pregnant Women

            • Description: Screen for preeclampsia with blood pressure measurements throughout pregnancy
            • Frequency: During each prenatal care visit

            Rh Incompatibility Screening

            Who Should Get It: Pregnant Women

            • Description: Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care
              • Recommended repeated Rh (D) antibody testing for all unsensitized Rh (D)-negative women at 24–28 weeks’ gestation unless the biological father is known to be Rh (D)-negative
            • Frequency: Twice — at first pregnancy visit and again at 24–28 weeks’ gestation (if qualified)
            • More Information: Initial testing is part of the obstetric panel

            Screening for Bacteria in Urine

            Who Should Get It: Pregnant Women 

            • Description: Screening for asymptomatic bacteriuria with urine culture
            • Frequency: Once at 12–16 weeks’ gestation or at first prenatal visit, if later

            Supplementation with Folic Acid

            Who Should Get It: Women planning or capable of pregnancy

            • Description: Women to take a daily supplement containing 0.4–0.8 mg (400–800mcg) of folic acid
            • Frequency: May vary based on your health so ask your doctor
            • Exclusions: Over-the-counter (OTC) folic acid supplements are only covered with a prescription

            Sexual Health

            Chlamydia Screening

            Who Should Get It: Sexually active women age 24 and younger or older women at increased risk of infection

            • Description: Screening for Chlamydia in sexually active women
            • Frequency: May vary based on your health so ask your doctor

            Contraception: Education, Counseling, and Contraceptive Methods Including Sterilization

            Who Should Get It: Women who are sexually active or thinking about becoming sexually active

            • Description: All FDA approved contraceptive methods, sterilization procedures, education and counseling related to contraceptives
            • Frequency: May vary based on your health so ask your doctor
            • More information:
              • Anesthesia services will pay at 100% only for sterilization
              • Services for contraceptive device removal will be provided with no cost sharing to appropriate groups
              • The following contraceptive methods (devices and associated procedures, such as device removal, and pharmaceutical contraceptives) for women with reproductive capacity:
                • OTC contraceptives (female condoms, all products; sponges, all products; spermicides, all products)
                • Emergency contraception (i.e., morning after pill, Plan B, ella)
                • Cervical caps
                • Diaphragms
                • Injections (only covered as preventive for Medoxyprogesterone Acetate 150 mg, which is the only drug and dosage used for contraception)
                • Implantable rods
                • IUDs
                • Generic oral contraceptives (all generic contraceptives will be covered as preventive; brand oral contraceptives will continue to require member cost sharing (e.g., deductible, copay, and/or coinsurance)
                • Trans-dermal contraceptives (i.e., contraceptive patches)
                • Vaginal rings (i.e., Nuvaring)
                • View a complete list of preventive oral contraceptives
              • Diaphragms are available only through the pharmacy and IUDs are available only through a professional provider
              • If there is a medical reason you cannot take a generic contraceptive, your doctor should review this ACA Copay Waiver Criteria; if you meet these criteria, they can submit this information on this fax form.
              • Diaphragms, vaginal rings, contraceptive patches, female condoms, sponges, spermicides, and emergency contraception are available only with a prescription
            • Exclusions:
              • Hysterectomies are not performed solely for sterilization so are not covered as preventive.
              • Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room.
              • Separately billed services are not covered under preventive services and are subject to the normal benefits based on place of service

            Contraception: Religious Organizations

            What is a Religious Organization: A religious organization refers to all employer groups defined under federal law that may limit or not cover contraceptive services due to the type of organization or that have a religious objection to these services.

            Some Blue Cross NC members who are employees of religious organizations and their dependents:

            • may not have contraceptive benefits
            • may have them as a covered benefit, but not as a preventive care benefit covered at 100%
            • may not have contraceptive benefits through your group medical plan
            • may have coverage through a separate Contraception-only policy

            Talk to your employer or check your benefit booklet to confirm your coverage for these benefits and any limitations.

            Gonorrhea Screening

            Who Should Get It: Sexually active women age 24 and younger or older women at increased risk of infection

            • Description: Screening for Gonorrhea in sexually active women
            • Frequency: May vary based on your health so ask your doctor

            Hepatitis B Screening

            Who Should Get It: Women at high risk of infection or pregnant women

            • Description: Screening for Hepatitis B in adults at high risk of infection or in pregnant women at their first prenatal visit
            • Frequency: May vary based on your health so ask your doctor. For pregnant women at their first prenatal visit.

            Hepatitis C Screening

            Who Should Get It: Women aged 18-79

            • Description: Screening for Hepatitis C in adults aged 18-79.

            Frequency: May vary based on your health so ask your doctor

            HIV Infection Prevention with Pre-exposure Prophylaxis

            Who Should Get It: Persons at high risk of acquiring HIV

            • Description: Offer preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition
            • More Information: Medications covered at 100%: emtricitabine/tenofovir (generic Truvada). For members who are clinically unable to utilize generic Truvada, brand Truvada, Viread, or Descovy may be made available by completing this form and faxing it to the number on the bottom of this document.
            • Frequency: May vary based on your health so ask your doctor
            • Effective: at renewal on or after July 1, 2020

            HIV Screening

            Who Should Get It: Women to age 65 or older if at increased risk

            • Description: Screening for Human Immunodeficiency Virus (HIV). Older women who are at increased risk should also be screened
            • Frequency: May vary based on your health so ask your doctor

            Behavioral Counseling to Prevent Sexually Transmitted Infections (STIs)

            Who Should Get It: Sexually active women

            • Description: Behavioral counseling for sexually active women
            • Frequency: May vary based on your health so ask your doctor

            Syphilis Screening

            Who Should Get It: Women at high risk of infection and pregnant women

            • Description: Screening for Syphilis in those at increased risk of infection or in pregnant women
            • Frequency: May vary based on your health so ask your doctor

            Mental Health and Substance Abuse

            Anxiety Screening

            Who Should Get It: Adult Women

            • Description: Screening for anxiety in adult women, including those who are pregnant or postpartum.
            • Frequency: May vary based on your health so ask your doctor

            Unhealthy Alcohol Use Screening and Counseling

            Who Should Get It: Age 18 and older, including pregnant women

            • Description: Screen adults for unhealthy alcohol use and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use
            • Frequency: May vary based on your health so ask your doctor

            Unhealthy Drug Use: Screening

            Who Should Get It: Age 18 and older

            • Description: Ask questions about unhealthy drug use in adults 18 years or older. Screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. (Screening refers to asking questions about unhealthy drug use, not testing biological specimens.)
            • Frequency: May vary based on your health so ask your doctor

            Depression Screening

            Who Should Get It: Age 18 and older

            • Description: Screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up
            • Frequency: Part of any problem or preventive office visit

            Intimate Partner Violence Screening

            Who Should Get It: Women of reproductive age

            • Description: Doctor should provide or refer women who screen positive to ongoing support services
            • Frequency: At least annually

            Tobacco Use Counseling

            Who Should Get It: Age 18 and older; when pregnant

            • Description: Ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration-approved pharmacotherapy for cessation to adults who use tobacco
            • Frequency: May vary based on your health so ask your doctor
            • More Information:
              • Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT.
              • FDA-approved tobacco cessation prescription medications and OTC nicotine replacement therapy (NRT) covered at 100%.
                • NRT through QuitlineNC is available without a prescription. Members must enroll in the multi-call program to qualify for up to 12 weeks of NRT. Limited to a 90 day supply each for two cessation efforts.
                • NRT through the pharmacy benefit is available only with a prescription.
                • No prescription medication or NRT limit when received via pharmacy benefit

            Nutrition and Wellness

            Fall Prevention

            Who Should Get It: Age 65 and older

            • Description: Exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls.
            • Frequency: May vary based on your health so ask your doctor

            Healthy Diet Counseling

            Who Should Get It: Overweight/obese adults with cardiovascular risk factors

            • Description: Offer or refer adults who meet criteria to intensive behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease (CVD) prevention
            • Frequency: May vary based on your health so ask your doctor
            • More Information: Preventive care includes 4 treatments provided by a physician and unlimited nutritional counseling visits by a licensed dietician or nutritionist

            Weight Loss to Prevent Obesity Related Morbidity and Mortality in Adults

            Who Should Get It: Age 18 and older

            • Description: If your body mass index (BMI) is 30 or higher, your doctor should refer you to or offer you intensive, multi-component behavioral interventions
            • Frequency: May vary based on your health so ask your doctor
            • More information: Preventive care includes 4 treatments provided by a physician and unlimited nutritional counseling visits by a licensed dietician or nutritionist

            Urinary Incontinence Screening

            Who Should Get It: All women

            • Description: Screening should assess whether women experience urinary incontinence and whether it impacts their activities and quality of life. Clinicians should refer women for further evaluation and treatment if indicated
            • Frequency: Annual

            Well Women Visits

            Who Should Get It: Women, dependent children up to age 26, pregnant women

            • Description: For women and dependent children to get recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care specified as preventive on this site regardless of whether the member has maternity coverage; this well-woman visit should, where appropriate, include other preventive services listed on this page
            • Frequency: Annual, although Health and Human Services recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman's health status, health needs and other risk factors

            Immunizations

            The following are the recommended vaccines for women 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 for more information.

            • Haemophilus influenza type b
            • Herpes Zoster (Shingles)1
            • Hepatitis A
            • Hepatitis B
            • Human papillomavirus (HPV)2
            • Influenza (Flu)
            • Measles, mumps, rubella (MMR)
            • Meningococcal
            • Pneumonia
            • Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap)
            • Varicella (Chicken Pox)

            1 If you have gotten one dose of Zostavax vaccine for shingles, you should also get the two doses of Shingrix vaccine.

            2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines.

            Medications

            List of all medications that are covered at 100% on all formularies.


            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.

            Still have questions?

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