Page 38 - SOLO Member Guidebook

WHICH PLAN?

IN-NETWORK SERVICES NOT manual breast pump, and breastfeeding supplies
SUBJECT TO COST SHARE - Screening and counseling for interpersonal and

domestic violence for all women and adolescents
In-Network prevention and wellness services as
• Bone density screenings, age 60 or older, one every
defined by the United States Preventive Service Task
23 months
Force (listed below) are exempt from all member
cost share (deductible, copayment and coinsurance) • Screening for colorectal cancer using fecal occult blood
under the Patient Protection and Affordable Care Act testing, sigmoidoscopy, or colonoscopy, age
(PPACA). Services that are exempt from cost share 50-75, one per year
must be identified by the specific code(s). The code(s) • Routine mammography screening, age 40 or older,
your health care provider submits must match one per year
ConnectiCare’s coding list to be exempt from all • Immunizations recommended by the Advisory
cost share. Committee on Immunization Practices of the CDC
• Outpatient laboratory services, one per year:

• Routine physical exam and appropriate screening and - Cervical cancer and cervical dysplasia screening -
counseling (including but not limited to depression, pap smear
obesity and sexually transmitted infections), one - Lipid cholesterol screening for adults and children
per year at risk
• Preventive care and screenings for infants, children - Fasting plasma glucose or hemoglobin A1c, age 18
and adolescents supported by the Health Resources and older for people at risk for diabetes
and Services Administration (including but not - Hematocrit and hemoglobin, for children up to age 21
limited to depression, obesity and sexually - Lead screening, for children up to age 6
transmitted infections) - Tuberculin testing, for children up to age 21
• Preventive care and screenings for women - Chlamydia, syphilis and gonorrhea screening for
supported by the Health Resources and Services females all ages
Administration - Human immunodeficiency virus screening - HIV
- At least one well-woman preventive care visit annu- testing (no limit)
ally to obtain the recommended preventive services - Hypothyroidism screening in newborns, under 3
- Screening for diabetes during pregnancy, two months of age
per pregnancy - Screening for phenylketonuria (PKU) in newborns,
- Human Papillomavirus (HPV) testing, age 30 or under 3 months of age
older, one per year - Screening for sickle cell disease in newborns, under
- Counseling on sexually transmitted infections for 3 months of age
all sexually active women, two per year - Hepatitis B screening for adolescents and adults

- Counseling and screening for human immune- at risk
deficiency virus (HIV) for all sexually active women - Hepatitis C screening for adults at risk
- Contraceptive methods approved by the Food and - Lung Cancer screening for adults ages 55-80 who
Drug administration, sterilization procedures and have smoked
contraceptive patient education and counseling • Routine vision screening, up to age 21, one per year
- Comprehensive lactation support, counseling, a when services are rendered by a primary care provider

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