Page 5 - Tritrax Benefit Guide Effective 9-1-2020

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

JUST FOR WOMEN

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