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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
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Cervical Cancer ScreeningWho Should Get It: Women age 21 - 65
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Colorectal Cancer ScreeningsAge 45 - 75*
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Lung Cancer ScreeningWho Should Get It: Age 50 - 80 and high risk due to smoking or other exposure
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Behavioral Counseling to Prevent Skin CancerWho Should Get It: Age 10 - 24 with fair skin
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Additional Services for Women at High-risk for Breast Cancer
BRCA Risk Assessment and Genetic Counseling/TestingWho Should Get It: Women who have personal or family history of breast, ovarian, tubal or peritoneal cancer or ancestry associated with breast cancer susceptibility
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Breast Cancer Preventive MedicationsWho 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
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Disease Prevention and Heart Health
Diabetes ScreeningWho Should Get It: Adults aged 35 to 70 who are overweight or obese; certain women after pregnancy
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High Blood Pressure, or Hypertension, ScreeningWho Should Get It: Age 18 and older
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Latent Tuberculosis Infection ScreeningWho Should Get It: Age 18 and older if at increased risk
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Osteoporosis (Bone Density) ScreeningWho Should Get It: Women age 65 and older, younger high-risk women
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Statin Use for the Primary Prevention of Cardiovascular Disease (CVD) in AdultsWho Should Get It: Adults aged 40-75 with certain risk factors
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Pregnancy and Childbirth
Behavioral Counseling Interventions for Healthy Weight and Weight Gain in PregnancyWho should get it: Pregnant adults
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Breastfeeding Support, Supplies and CounselingWho Should Get It: Pregnant women/women who have delivered a baby recently
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Gestational Diabetes Mellitus ScreeningWho Should Get It: Pregnant Women
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HIV ScreeningWho Should Get It: Pregnant Women
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Low-dose Aspirin for High-risk Pregnant WomenWho Should Get It: Pregnant women at high risk for Preeclampsia
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Maternal Depression Screening and Prevention of Perinatal DepressionWho Should Get It: Pregnant and postpartum women
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Preeclampsia ScreeningWho Should Get It: Pregnant Women
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Rh Incompatibility ScreeningWho Should Get It: Pregnant Women
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Screening for Bacteria in UrineWho Should Get It: Pregnant Women
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Supplementation with Folic AcidWho Should Get It: Women planning or capable of pregnancy
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Sexual Health
Chlamydia ScreeningWho Should Get It: Sexually active women 24 years or younger and in women 25 years or older who are at increased risk of infection
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Contraception: Education, Counseling, and Contraceptive Methods Including SterilizationWho Should Get It: Women who are sexually active or thinking about becoming sexually active
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Contraception: Religious OrganizationsWhat 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:
Talk to your employer or check your benefit booklet to confirm your coverage for these benefits and any limitations. |
Gonorrhea ScreeningWho Should Get It: Sexually active women 24 years or younger and in women 25 years or older who are at increased risk of infection
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Hepatitis B ScreeningWho Should Get It: Women at high risk of infection or pregnant women
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Hepatitis C ScreeningWho Should Get It: Women aged 18-79
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HIV Infection Prevention with Pre-exposure ProphylaxisWho Should Get It: Persons at high risk of acquiring HIV
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HIV ScreeningWho Should Get It: Women to age 65 or older if at increased risk
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Behavioral Counseling to Prevent Sexually Transmitted Infections (STIs)Who Should Get It: Sexually active women
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Syphilis ScreeningWho Should Get It: Women at high risk of infection and pregnant women
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Mental Health and Substance Abuse
Anxiety ScreeningWho Should Get It: Adult Women
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Unhealthy Alcohol Use Screening and CounselingWho Should Get It: Age 18 and older, including pregnant women
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Unhealthy Drug Use: ScreeningWho Should Get It: Age 18 and older
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Depression ScreeningWho Should Get It: Age 18 and older
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Intimate Partner Violence ScreeningWho Should Get It: Women of reproductive age
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Tobacco Use CounselingWho Should Get It: Age 18 and older; when pregnant
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Nutrition and Wellness
Fall PreventionWho Should Get It: Age 65 and older
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Healthy Diet and Physical Activity Counseling for Cardiovascular Disease PreventionWho Should Get It: Adults with cardiovascular risk factors
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Weight Loss to Prevent Obesity Related Morbidity and Mortality in AdultsWho Should Get It: Age 18 and older
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Urinary Incontinence ScreeningWho Should Get It: All women
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Well Women VisitsWho Should Get It: Women, dependent children up to age 26, pregnant women
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Healthy Weight CounselingWho Should Get It: Women aged 40 to 60 years with normal or overweight body mass index (BMI) of 18.5 - 29.9
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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.
- COVID-19
- 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.