Member Services: 877-514-2442

PREVENTIVE CARE

Common Ground Healthcare Cooperative plans include benefits for two types of preventive care. There is a specific list of preventive care services as defined by the Affordable Care Act that are provided at no cost to you as long as you get them through an in-network doctor. But there are also things that you might consider preventive that are not on this list and could be applied to co-payments, coinsurance and deductibles. The lists are provided below.

WE WANT TO  STRENGTHEN YOUR POWER TO AVOID SURPRISE CHARGES.

Preventive care has resulted in surprise bills for our members. Deciding what preventive services to receive is between you and your in-network doctor, but it’s our job help you understand your benefits and some pitfalls that have caused other members to pay more than they expected. The resources to the right are full of helpful tips you should review before receiving preventive care. Feel free to print these off and take them with you to the doctor’s office. It may help you avoid a costly charge for a test that’s not highly recommended by the US Preventive Services Task Force.

TIP #1: UNDERSTAND THE DIFFERENCE BETWEEN PREVENTIVE AND DIAGNOSTIC CARE

To avoid surprise charges, it is important to understand that “preventive care” is when you don’t have any history, symptoms or other health concerns about the issue for which they are testing or screening. When you have a history or a health concern, those tests and screenings become “diagnostic” and not preventive because the doctor is trying to diagnose a problem. Diagnostic services are typically covered but they are not covered at no cost to you. They will apply to your benefits (copays, deductibles and coinsurance).

No-Cost-Share Preventive Services Recommended for Adults*
  • Abdominal Aortic Aneurysm One time Screening
    • Men aged 65-75 with a history of smoking
  • Alcohol Misuse Screening & Counseling
  • Aspirin Use
    • If ordered by physician and a prescription is received from the provider
    • Prescription filled using pharmacy benefit
    • Female ages 55-79; Male ages 45-79
  • Blood Pressure Screening — This is part of a preventive care wellness exam or office visit
  • Cholesterol Screening – Age 20 years and older
  • Colorectal Cancer Screening- — Age 45 and older includes colonoscopy, sigmoidoscopy, test for occult blood, polyp removal and related pathology when the colonoscopy is preventive and not diagnostic
  • Prostate Cancer Screening — Men aged 40 years and older
  • Depression Screening
  • Diabetes Type 2 Screening
  • Diet Counseling and Obesity Screening (Screening and Counseling) for adults with risk factors
  • Syphilis screening
  • Vaccinations/Immunizations:
    • Hepatitis A
    • Hepatitis B
    • Herpes Zoster-Shingles
    • Human Papilloma Virus (HPV)
    • Influenza -flu shot
    • Meningococcal
    • Pertussis
    • Pneumococcal – Pneumonia
    • Tetanus
    • Varicella-Chicken Pox
  • Statin preventive medication – ages 40-75 with certain risk factors
  • Tobacco Use Screening & Interventions in Adults and Pregnant Women
  • Tuberculosis Screening

If you have questions regarding specific service codes, please contact Member Services at 877.514.2442 for more information about how the services may apply to your benefits.

No-Cost-Share Preventive Services Recommended for Women*
  • Prenatal Test/Screening:
    • Anemia Screening
    • Bacteriuria Screening
  • Breast Cancer Genetic Test Counseling and Evaluation for BRCA
  • BRCA Testing & Screening — Must have a family history of ovarian or breast cancer
  • Breast Cancer Mammography Screening — Female 40 years and older
  • Breast Pumps — If ordered by a licensed professional after the birth of a child. Coverage is limited to one standard manual, simple breast pump or one basic single electric pump. A hospital-grade model is not covered.
  • Breastfeeding Comprehensive Support & Counseling
  • Cervical Cancer Screening-Pap Smear — Female ages 21-64
  • Chemoprevention of Breast Cancer Counseling — Females at risk for breast cancer
  • Chlamydia Infection Screening
    • Female and under 25 years if sexually active
    • Female and 25 years and older with multiple sex partners, pregnant or of child bearing years
  • Contraception — See medications and devises listed on our Prescription Drug formulary
  • Sterilization — Tubal Ligation
  • Domestic & Interpersonal Violence Screening & Counseling
  • Folic Acid
    • If ordered by physician and a prescription is received from the provider
    • Prescription filled using pharmacy benefit
    • Pregnant females or of child bearing age
  • Gestational Diabetes Screening — Pregnant females
  • Gonorrhea Screening — Females who are sexually active or pregnant
  • Hepatitis B Screening — Pregnant females
  • HIV Screening — Pregnant females
  • Human Papilloma Virus (HPV) DNA Test
  • Osteoporosis Screening – Bone Density
  • Rh Incompatibility Screening — Pregnant females
  • Rubella Screening by History of Vaccination or by Serology — Pregnant females
  • Syphilis Screening — Pregnant females or If at risk for syphilis Infection
  • Well-Women Visit
  • Well-Women Prenatal Visits — Pregnant females

If you have questions regarding specific service codes, please contact Member Services at 877.514.2442 for more information about how the services may apply to your benefits.

No-Cost-Share Preventive Services Recommended for Children*
  • Physician Visit (well-child/well-baby/health check)
  • Autism Screening
  • Behavioral Assessments
  • Blood Pressure Screening
  • Cervical Dysplasia Screening — Females under 18 and sexually active
  • Depression Screening in Children and Adolescents
  • Developmental Screening — Prenatal through age 21
  • Dyslipidemia Screening — Ages 2 through 21
  • Gonorrhea preventive Medication
  • Hearing Screening
  • Height, Weight and Body Mass Index Measurements
  • Hematocrit or Hemoglobin Screening (Anemia)
  • Hemogloinopathies or sickle cell screening
  • Childhood Vaccinations/Immunizations:
    • Diphtheria
    • Haemophilus Influenza Type B (HIB)
    • Hepatitis A
    • Hepatitis B
    • Human Papilloma Virus
    • Inactivated Polio Virus
    • Influenza Shot
    • Measles
    • Mumps
    • Rubella
    • Meningococcal-Child
    • Pneumococcal – Pneumonia
    • Rotavirus
    • Varicella-Chicken Pox
  • Iron Supplements
  • If ordered by physician and a prescription is received from the provider
  • Prescription filled using pharmacy benefit
  • Lead Poisoning Screening
  • Medical History
  • Obesity Screening and Counseling in Children and Adolescents
  • Tobacco Prevention Interventions for Children & Adolescents
  • Oral Health risk assessment
  • Sexually Transmitted Infection (STI) Prevention Counseling & Screening
  • Tuberculin Testing (TB skin test)
  • Skin Cancer Prevention Counseling
  • Vision Screening in Children

Newborn Screening (0-90 Days):

  • Hypothyroidism Screening
  • Phenylketonuria (PKU) Screening
  • Sickle Cell Screening
  • Metabolic Screening

If you have questions regarding specific service codes, please contact Member Services at 877.514.2442 for more information about how the services may apply to your benefits.

Click here to download a full printable list of what may be no-cost-share preventive health services.

Preventive health services are only covered at 100% if received from an in-network provider.

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