In 2011, your annual physical exam under both Standard and Basic Options is free when you use a Preferred provider. The Affordable Care Act (ACA) requires that specific preventive services be covered in full — at no cost to the member — when the provider was Preferred in the Plan prior to 2011.

Members will continue to be responsible for a Preferred office visit copayment if the primary purpose of the visit was to treat a medical condition. If the Preferred provider bills for a preventive service during the office visit to treat a medical condition, the preventive service itself will be paid in full. For more information, please review pages 33-36 in Section 5(a) of the 2011 brochure .

The list below highlights all of the new preventive care services that were added for adults and children, effective January 1, 2011, in order to comply with the Affordable Care Act.

New preventive services for adults as of January 1, 2011:

  • Osteoporosis screening for women age 60 and over
  • Genetic counseling and evaluation for women with family history of breast and/or ovarian cancer
  • Measles, Mumps, Rubella immunization
  • Tetanus, Diphtheria, Pertussis immunization
  • Varicella immunization
  • Nutritional counseling*
  • Education and individual coaching on breastfeeding
  • Aspirin for men age 45-79 and for women age 55-79
  • Folic acid for women capable of pregnancy

New preventive services for children as of January 1, 2011:

  • Nutritional counseling*
  • Iron supplements for children from age 6 months through 12 months
  • Oral fluoride supplements for children from age 6 months through 5 years

* Prior to 2011, regular medical benefits were available for nutritional counseling; to comply with the ACA, nutritional counseling is now eligible for preventive care benefits.

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