2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 47
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 47
Benefit Description
Preventive Care, Child (cont.)
Notes:
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Preventive Care, Child (cont.)
Note: U.S. FDA licensure may restrict the use of certain vaccines to specific age ranges, frequencies, and/or other patient-specific indications, including gender.
- Nutritional counseling
Note: Benefits are limited to individual nutritional counseling services. We do not provide benefits for group counseling services.
Note: When nutritional counseling is via the contracted telehealth provider network, we provide benefits as shown here for Preferred providers. Refer to Section 5(h), Wellness and Other Special Features, for information on how to access a telehealth provider.
- Screening for hepatitis B for children age 13 and over
- Screening for chlamydial infection
- Screening for gonorrhea infection
- Cervical cancer screening tests
- Pap tests of the cervix
- Human papillomavirus (HPV) tests of the cervix
- Screening for human immunodeficiency virus (HIV) infection
- Screening for syphilis infection
- Screening for latent tuberculosis infection for children ages 18 through 21
Notes:
- If your child receives both preventive and diagnostic services from a Preferred provider on the same day, you are responsible for paying the cost-share for the diagnostic services.
- Any procedure, injection, diagnostic service, laboratory, or X-ray service done in conjunction with a routine examination and not included in the preventive listing of services will be subject to the applicable member copayments, coinsurance, and deductible.
- See page 98 for our payment levels for medications to promote better health as recommended under the Affordable Care Act.
- A complete list of preventive care services recommended under the U.S. Preventive Services Task Force (USPSTF) is available online at:
www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/
A complete list of women’s preventive services can be found at www.healthcare.gov/preventive-care-women/
HHS: www.healthcare.gov/preventive-care-benefits
For additional information: www.healthfinder.gov/myhealthfinder/default.aspx
For a complete list of the American Academy of Pediatrics Bright Futures Guidelines, go to brightfutures.aap.org/Pages/default.aspx
You Pay
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