Member Services: 877-514-2442

PREVENTIVE CARE

Common Ground Healthcare Cooperative offers coverage for two types of preventive care. There is preventive care that costs you nothing, and then there is preventive care that might be applied to copayments, coinsurance and deductibles. To get the most out of your health insurance coverage, please take a few minutes to review this fact sheet, and then schedule your preventive care appointment today.

Preventive care starts with an annual checkup with any of the following primary care providers:

  • your family doctor
  • a general medicine physician
  • your OB/GYN
  • your pediatrician
  • a doctor that specializes in internal medicine
  • a nurse practitioner
What May Be Preventive Health Services 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 50 and older includes colonoscopy, sigmoidoscopy, test for occult blood
  • Prostate Cancer Screening — Men aged 40 years and older
  • Depression Screening
  • Diabetes Type 2 Screening
  • Healthy Diet and Physical Activity Counseling – for adults with cardiovascular risk factors
  • Vaccinations/Immunizations:
    • Hepatitis A
    • Hepatitis B
    • Herpes Zoster-Shingles
    • Human Papilloma Virus (HPV)
    • Influenza -flu shot
    • Meningococcal
    • Pertussis
    • Pneumococcal – Pneumonia
    • Tetanus
    • Varicella-Chicken Pox
  • Obesity Screening (Screening and Counseling) in Adults
  • Tobacco Use Screening & Interventions in Adults and Pregnant Women

Click here to download the PDF of preventive health services for men

Click here to download the PDF of preventive health services and codes for women

Click here to download the PDF of preventive immunizations and codes

What May Be Preventive Health Services 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

Click here to download the PDF of preventive health services and codes for women

Click here to download the PDF of preventive immunizations and codes

What May Be Childhood Preventive Services
  • 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

Click here to download the PDF of preventive health services and codes for children

Click here to download the PDF of preventive immunizations and codes

Click here to download the full list of what may be covered preventive health services.

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

HOW TO AVOID SURPRISE CHARGES WHEN SCHEDULING YOUR PREVENTIVE VISIT

When you schedule an appointment for any no-cost preventive services, make it known that you’re interested in getting your free preventive screenings and want to be told if any services fall outside the list of approved no-cost services. If you’re visiting your doctor, don’t be afraid to ask questions when he or she recommends additional testing and treatment. If they don’t meet our definition of preventive screening, you’ll need to pursue those recommendations with the knowledge that you’ll likely have some cost-sharing responsibilities. You can also call CGHC Member Services at 877.514.2442.

If you are getting a colonoscopy, talk to your doctor about whether it will be preventive care or diagnostic. Diagnostic visits are not free. Sometimes, if a doctor finds a polyp during a preventive screening colonoscopy, they will bill us for a diagnostic colonoscopy instead of a preventive one, which can cost you money. If this occurs, please have your doctor’s office contact us and/or send in the medical records for review and reconsideration of your claim.