Page 30 - SOLO Member Guidebook

Hepatitis B screening for adolescents and adults at risk
Screening for sickle cell disease in newborns, under 3

Hepatitis C screening for adults at risk Lung Cancer screening for adults ages 55-80 who have Routine vision screening, up to age 21, one per year when services are rendered by a primary care provider Routine hearing screening up to age 21 when rendered by a Dental caries prevention up to age 5 when rendered by a primary Developmental, autism, and psychosocial/behavioral assess- ments up to age 21 when rendered by a primary care provider Diet

3 months of age months of age primary care provider care provider • Tobacco cessation interventions who have ever smoked

- - - - smoked pregnant at risk
• • • • • • • • • •
Preventive Care and Wellness Services

patient education and counseling administration, sterilization procedures and contraceptive Comprehensive lactation support, counseling, a manual breast pump, and breastfeeding supplies Screening and counseling for interpersonal and domestic violence for all women and adolescents Bone density screenings, age 60 or older, one every 23 months Screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy, age 50-75, one

IN-NETWORK SERVICES NOT SUBJECT TO COST SHARE
- - - - - - - all ages - (no limit) - of age -
• • • • • This is a general description of benefits. Please refer to the detailed benefit summaries or applicable individual policy for benefit limits, exclusions and other details. Producers can access benefit summaries at www.connecticare.com. The policy will prevail for all benefits, conditions, limitations and exclusions. Rates displayed are quoted rates only. Final rates are subject to D

exempt from all member cost share (deductible, copayment and
identified by the specific code(s). The code(s) your health care
Act (PPACA). Services that are exempt from cost share must be
In-Network prevention and wellness services as defined by the
coinsurance) under the Patient Protection and Affordable Care
United States Preventive Service Task Force (listed below) are
provider submits must match ConnectiCare’s coding list to be

exempt from all cost share. Routine physical exam and appropriate screening and counseling (including but not limited to depression, obesity and sexually transmitted infections), one per year Preventive care and screenings for infants, children and adolescents supported by the Health Resources and Services Administration (including but not limited to depression, obesity and sexually transmitted infections) Preventive care and screen

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