Summary of Preventive Services Under the
Patient Protection and Affordable Care Act

As of August 1, 2012: The preventive services set forth below apply to plans that have elected or are required to provide preventive services under the Patient Protection and Affordable Care Act.  Such preventive services are covered where clinically appropriate, under recommendations of the United States Preventive Services Task Force and supporting evidence. Limitations may apply with respect to the availability, setting, frequency, or method of a service or treatment.


  • Well child visits (birth to age 21) to include
    • Screenings for autism
    • Developmental screenings - under age 3
    • Hearing screenings for newborns
    • Screening for cervical dysplasia for sexually active females
    • Hematocrit or hemoglobin screenings
    • HIV screening
    • Vision screening
    • Obesity screening
    • Testing for lead
    • Certain diagnostic screenings for newborns
  • Immunizations for Children
    • Diphtheria, Tetanus, Pertussis
    • Hepatitis A
    • Hepatitis B
    • Human Papillomavirus
    • Influenza
    • Influenza B
    • Measles, mumps and rubella
    • Meningococcal
    • Pneumococcal
    • Varicella
    • Rotavirus
    • Inactivated Polio
  • Health, diet and weight counseling 
  • Alcohol and drug assessments for older children
  • Preventive Drugs for Children  
    • Fluoride – preschool age (P)
    • Iron – 6-12 mo. risk of anemia (OTC*)


  • Preventive Care Visits include screenings for
    • Cholesterol
    • High blood pressure
    • Type 2 diabetes
    • Depression
    • Alcohol misuse
    • HIV
    • Obesity
    • One-time screening of abdominal aortic aneurysm
    • Osteoporosis
    • Anemia
    • Cervical cancer screening
    • Hepatitis B
    • Sexually transmitted diseases
    • Rh incompatibility and urinary tract infection screenings for pregnant women
    • Mammograms
    • Colonoscopies
    • Gestational diabetes screening
    • HPV DNA testing
    • Interpersonal and domestic violence screening and counseling
    • Breastfeeding support, supplies and counseling1
    • FDA approved contraceptive methods and counseling2
  • Health, diet and weight counseling for qualifying adults
  • Tobacco use screenings and cessation counseling
  • Preventive Drugs for Adults
    • Folic Acid – women of childbearing age (P)
    • Smoking Cessation (OTC*)
    • Aspirin (81mg) (OTC*)
  • FDA Approved Contraceptives
    • Female Condom (OTC*)
    • Diaphragm (P) with Spermicide (OTC*)
    • Sponge (OTC*) with Spermicide (OTC*)
    • Cervical Cap (P) with Spermicide (OTC*)
    • Spermicide (OTC*)
    • Oral Contraceptive (generics only) (P) 
    • Contraceptive Patch (P)
    • Contraceptive Ring (P)
    • Shot/Injection3 (generic only) (P)
    • Morning After Pill (generic only)
      •  Over 17 years of age (OTC*)
      • Under 17 years of age (P)
    • IUD (inserted by doctor)
    • Contraceptive Implant System (inserted by doctor) 
    • Sterilization Implant
    • Sterilization Surgery
  • Breast Pumps and Supplies
    Breast pumps and supplies are provided under the Durable Medical Equipment (DME) benefits of the contract.
    • Coverage is provided for:
      • Manual breast pumps (rental and/or purchase)
      • Electric breast pump (rental and/or purchase)
      • Hospital grade electric breast pump (rental)
    • Replacement supplies include:
      • Breast pump replacement tubing
      • Adapter for breast pump
      • Cap for breast pump bottle
      • Breast shield & splash protector for use with breast pump
      • Polycarbonate bottle for use with breast pump
      • Locking ring for breast pump

3Includes Brand Name Depo-SubQ Provera 104 (injection)
(P) Prescription Required
(OTC) Over the Counter
* Requires a prescription from a physician and must be purchased at a pharmacy to obtain the zero-cost share

>> Additional information on Preventative Services is available at