Page 6 - Benefit Guide_SIPS_2020_Revised 2-12-21

Preventive Care Coverage:

One of the most valuable benefits included with your benefit package is preventive care coverage which covers 100% of
eligible preventive services. NO Dr. copays or deductibles apply! Like all other services, you must see In-Network Providers.
This means that you and your covered dependents have access to a variety of medical tests, screenings, annual exams,
and immunizations which may help reduce your risk of developing health conditions in the future and avoid expensive
treatment down the road.

FOR ADULTS FOR CHILDREN
Annual preventive medical history and physical exam Annual preventive medical history and physical exam

SCREENINGS FOR: SCREENINGS FOR:
 Abdominal aortic aneurysm  Autism
 Alcohol abuse and tobacco use  Cervical dysplasia
 Cardiovascular disease (CVD) including cholesterol screening  Critical congenital heart defect screening for newborns
and statin use for the prevention of CVD  Depression
 Colorectal and lung cancer  Developmental delays
 Depression  Dyslipidemia (for children at higher risk)
 Falls prevention  Hearing loss, hypothyroidism, sickle cell disease and
 High blood pressure, obesity and diabetes phenylketonuria (PKU) in newborns
 Sexually transmitted infections, HIV, HPV and hepatitis  Hematocrit or hemoglobin
 Tuberculosis  Lead poisoning
 Obesity
COUNSELING FOR:  Sexually transmitted infections and HIV
 Alcohol misuse  Tuberculosis
 Domestic violence  Vision Screening
 Healthy diet and physical activity counseling for adults who
are overweight or obese and have additional cardiovascular AND COUNSELING:
risk disease factors  Alcohol and drug use assessment for adolescents
 Obesity  Obesity counseling
 Sexually transmitted infections  Oral health risk assessment, dental caries prevention
 Skin cancer prevention  fluoride varnish and oral fluoride supplements
 Tobacco use, including certain medicine to stop  Skin cancer prevention counseling
 Use of aspirin to prevent heart attacks
JUST FOR WOMEN

 Aspirin for preeclampsia prevention
 Breast cancer screening, genetic testing and counseling
 Breastfeeding support, supplies and counseling  Diphtheria, Pertussis, Tetanus
 Certain contraceptives and medical devices, morning after  Haemophilus Influenzae Type B (Hib)
pill, and sterilization to prevent pregnancy  Hepatitis A and B
 Cervical cancer screening  Human Papillomavirus (HPV)
 Chlamydia, gonorrhea, syphilis, HIV and hepatitis B screenings  Inactivated Poliovirus (Polio)
 Counseling for alcohol and tobacco use during pregnancy  Influenza (Flu)
 Diabetes melitus screening after pregnancy  Measles, Mumps, Rubella (MMR)
 Folic acid supplementation during pregnancy  Meningitis
 Human papillomavirus (HPV) DNA test  Pneumococcal
 Osteoporosis screening  Rotavirus
 Screenings during pregnancy, including screenings for anemia,  Varicella (Chicken Pox)
gestational diabetes, bacteriuria, Rh(D) compatibility
 Urinary incontinence screening  Zoster (Herpes, Shingles
Pediatric Dental:
 There are some pediatric dental check-up available AFTER your medical deductible and co-ins. is met
Pediatric Vision:
6  There are some pediatric vision benefits available. Your deductible does not apply. Copays do apply. Please see your benefit
summary for additional information.