Preventive

health care.
Understanding what’s covered.

What is preventive care? What’s not considered preventive care?

Preventive care is a specific group of services Once you have a symptom or your health care provider
recommended when you don’t have any symptoms and diagnoses a health issue, additional tests are not
haven’t been diagnosed with a related health issue. It considered preventive care. Also, you may receive other
includes your periodic wellness exam (check-up) and medically appropriate services during a periodic wellness
specific tests, certain health screenings, and most exam that are not considered preventive. These services
immunizations. Most of these services typically can take may be covered under your plan’s medical benefits, not
place during the same visit. You and your health care your preventive care benefits. This means you may be
provider will decide what preventive services are right for responsible for paying a share or all of the cost
you, based on your: depending on your plan, including deductible, copay
Age or coinsurance amounts.
•
• Gender Which preventive services are covered?
• Personal health history Many plans cover preventive care at no additional cost to
• Current health you when you use a health care provider in your plan’s
network. Use the provider directory on myCigna.com® for
Why do I need preventive care? a list of in-network health care providers and facilities.
Preventive care can help you detect problems at early See the following pages for the services and supplies
stages, when they may be easier to treat. It can also help considered preventive care under most health plans.
you prevent certain illnesses and health conditions from Coverage for services recommended specifically for
happening. Even though you may feel fine, getting your “men” or “women” is provided based on the anatomical
preventive care at the right time can help you take control characteristics of the individual and not necessarily the
of your health. gender of the individual as indicated on the claim and/or
an enrollment form.
Make a plan for preventive care.
Use this space to write down the details for your next Questions?
periodic wellness exam.
Check your plan materials, talk with your
Date: health care provider or call the number
Time: on the back of your ID card.
Questions for my provider:

855050 s 05/24 Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company or their affiliates.
Wellness exams

SERVICE GROUP CRITERIA AND FREQUENCY

Well-baby/well-child/well-person exams, including annual • Birth, 1, 2, 4, 6, 9, 12, 15, 18, 24 and 30 months
well-woman exam (includes height, weight, head circumference, BMI, • Additional visit at 2–4 days for infants discharged less than 48 hours after delivery
blood pressure, history, anticipatory guidance, education regarding risk • Ages 3 to 21, once a year
reduction, psychosocial/behavioral assessment) • Ages 22 and older, periodic visits as doctor advises

Routine immunizations covered under preventive care

• COVID-19 • Meningococcal (meningitis)
• Diphtheria, Tetanus Toxoids and Acellular Pertussis (DTaP, Tdap, Td) • Pneumococcal (pneumonia)
• Haemophilus influenzae type b conjugate (Hib) • Poliovirus (IPV)
• Hepatitis A (Hep A) • Respiratory Syncytial Virus (RSV)
• Hepatitis B (Hep B) • Rotavirus (RV)
• Human papillomavirus (HPV) • Varicella (chickenpox)
• Influenza vaccine • Zoster (shingles)
• Measles, mumps and rubella (MMR)

You may view the immunization schedules on the CDC website: cdc.gov/vaccines/schedules/.

Health screenings and interventions

SERVICE GROUP CRITERIA AND FREQUENCY

Abnormal blood glucose and type 2 diabetes screening/counseling Adults ages 40–70 who are overweight or obese; women with a history of gestational
diabetes mellitus
Anxiety screening Adults; children and adolescents, ages 8–18, includes pregnant and postpartum persons
Aspirin to reduce risk for preeclampsia 1
Adults ages 50–59 with risk factors; pregnant women at risk for preeclampsia
Autism screening 18, 24 months
Bacteriuria screening Pregnant women
Bilirubin screening Newborns before discharge from hospital
Breast cancer screening (mammogram) Women ages 40 and older, every 1–2 years
Breast cancer-discussion of benefits/risks of preventive medication Women ages 35 and older at risk
Breast-feeding support/counseling, supplies 2
During pregnancy and after birth
Cervical cancer screening (Pap test) Women ages 21–65, every 3 years
HPV DNA test alone or with Pap test Women ages 30–65, every 3 years
Chlamydia screening Sexually active women at risk
Cholesterol/lipid disorders screening 1
• S creening of children and adolescents ages 9–11 years and 17–21 years;
children and adolescents with risk factors ages 2–8 and 12–16 years
• All adults ages 40–75

= Men = Women = Children/adolescents

Health screenings and interventions (continued)

SERVICE GROUP CRITERIA AND FREQUENCY

Colon cancer screening1 The following tests will be covered for colorectal cancer screening, ages 45–75:
• Fecal occult blood test (FOBT) or fecal immunochemical test (FIT) annually
• Flexible sigmoidoscopy every 5 years
• Flexible sigmoidoscopy every 10 years + annual FIT
• Double-contrast barium enema (DCBE) every 5 years
• Colonoscopy every 10 years, including a follow-up colonoscopy, for when stool-based
tests reveal abnormal results
• Computed tomographic colonography (CTC)/virtual colonoscopy every 5 years –
Requires prior authorization
• Stool-based deoxyribonucleic acid (DNA) test (i.e., Cologuard) every 1–3 years
Congenital hypothyroidism screening Newborns
Critical congenital heart disease screening Newborns before discharge from hospital
Contraception counseling/education (including fertility
Women with reproductive capacity
awareness-based methods); contraceptive products and services1, 3, 4
Dental application of fluoride varnish to primary teeth at time of eruption
Children to age 6 years
(in primary care setting)
Dental caries prevention
Children older than 6 months
Evaluate water source for sufficient fluoride; if deficient prescribe oral fluoride1
Depression screening/Maternal depression screening Adults; Adolescents ages 12–18, including pregnant and postpartum women
Developmental screening 9, 18, 30 months
Developmental surveillance Newborn, 1, 2, 4, 6, 12, 15, 24 months. At each visit ages 3–21
Fall prevention in older adults (including assessment of risk, individual Community-dwelling adults ages 65 and older with risk factors
and group exercise, and physical therapy)
Folic acid supplementation1 Women planning or capable of pregnancy
Genetic counseling/evaluation and BRCA1/BRCA2 testing Women at risk, including those with a personal or family history of breast cancer,
ovarian cancer, tubal cancer or peritoneal cancer, or an ancestry associated with
BRCA 1/2 gene mutation
• Genetic counseling must be provided by an independent board-certified
genetic specialist prior to BRCA1/BRCA2 genetic testing
• BRCA1/BRCA2 testing requires precertification
Gestational diabetes screening Pregnant women with no symptoms of diabetes, at 24 weeks of pregnancy or after
Gonorrhea screening Sexually active women age 24 years and younger and older women at risk
Healthy diet and physical activity counseling Ages 6 and older, including pregnant persons – to promote healthy weight status; individuals
with risk factors for cardiovascular disease; behavioral health counseling while pregnant
Hearing screening (not complete hearing examination) All newborns by 2 months. Ages 4, 5, 6, 8, 10. Adolescents once between ages 11–14, 15–17
and 18–21
Hemoglobin or hematocrit 12 months
Hepatitis B screening Pregnant women; adolescents and adults at risk
Hepatitis C screening Adults ages 18–79
High blood pressure screening (outside clinical setting)2 Adults ages 18 and older without known high blood pressure
HIV Preexposure Prophylaxis (PrEP) for prevention of HIV infection1
HIV PrEP related services (HIV screening, kidney function testing, hepatitis Individuals at risk
B & C screening, pregnancy testing, sexually transmitted infection
screening/behavioral counseling, adherence counseling)

= Men = Women = Children/adolescents

Health screenings and interventions (continued)

SERVICE GROUP CRITERIA AND FREQUENCY

HIV screening and counseling Pregnant women; adolescents and adults 15 to 65 years; younger adolescents and older
adults at risk; sexually active women (adolescent/adult), annually
Intimate partner/interpersonal violence screening All women (adolescent/adult)
Lead screening 12, 24 months
Lung cancer screening (low-dose computed tomography) Adults ages 50–80 with 20 pack year smoking history, and currently smoke, or have quit
within the past 15 years. Computed tomography requires precertification
Metabolic/hemoglobinopathies (according to state law) Newborns
Obesity screening/counseling Ages 6 and older, all adults
Ocular (eye) medication to prevent blindness Newborns
Oral health evaluation/assess for dental referral 6, 9 months. Ages 12 months, 18 months–6 years for children at risk
Osteoporosis screening Age 65 or older (or under age 65 for women with fracture risk as determined by a Clinical
Risk Assessment Tool). Computed tomographic bone density study requires precertification
PKU screening Newborns
Perinatal depression preventive counseling Pregnant and postpartum women with risk factors
Hypertensive disorders of pregnancy screening
Pregnant women
(blood pressure measurement)
Prostate cancer screening (PSA) Men ages 45 and older or age 40 with risk factors
Rh incompatibility test Pregnant women
Sexually transmitted infections (STI) counseling Sexually active women, annually; sexually active adolescents; and men at increased risk
Sexually transmitted infections (STI) screening Adolescents ages 11–21
Sickle cell disease screening Newborns
Skin cancer prevention counseling to minimize exposure to ultraviolet
Ages 6 months–24 years
radiation
Statin use for the primary prevention of cardiovascular disease Adults ages 40–75 who have cardiovascular disease risk factors
Syphilis screening Individuals at risk; pregnant women
Tobacco use cessation: counseling/interventions1 All adults1; pregnant women
Tobacco use prevention (counseling to prevent initiation) School-age children and adolescents
Tuberculosis screening Children, adolescents and adults at risk
Ultrasound aortic abdominal aneurysm screening Men ages 65–75 who have ever smoked
Unhealthy alcohol use and substance abuse screening All adults; adolescents age 11–21
Unhealthy drug use screening All adults
Urinary incontinence screening Women
Vision screening (not complete eye examination) Ages 3, 4, 5, 6, 8, 10, 12, and 15 or as doctor advises

= Men = Women = Children/adolescents

1. Subject to the terms of your plan’s pharmacy coverage, certain drugs and products may be covered at 100%. Your doctor is required to give you a prescription, including for those that are
available over the counter (unless your state does not require a prescription for OTC products), for them to be covered under your Pharmacy benefit. Cost sharing may be applied for brand-
name products where generic alternatives are available. Please refer to Cigna’s “No Cost Preventive Medications by Drug Category” Guide for information on drugs and products with no
out-of-pocket cost.
2. Subject to the terms of your plan’s medical coverage, home blood pressure monitoring supplies, breast-feeding equipment rental and supplies may be covered at the preventive level. Your
doctor is required to provide a prescription for home blood pressure monitoring equipment and some breast pump equipment.
3.Examples include oral contraceptives; diaphragms; hormonal injections and contraceptive supplies (spermicide, condoms); emergency contraception.
4. Subject to the terms of your plan’s medical coverage, contraceptive products and services such as some types of IUD’s, implants and sterilization procedures may be covered at the
preventive level. Check your plan materials for details about your specific medical plan.
These preventive health services are based on recommendations from the U.S. Preventive Services Task Force (A and B recommendations), the Advisory Committee on Immunization Practices
(ACIP) for immunizations, the American Academy of Pediatrics’ Periodicity Schedule of the Bright Futures Recommendations for Pediatric Preventive Health Care, the Uniform Panel of the
Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children and, with respect to women, evidence-informed preventive care and screening guidelines supported by the
Health Resources and Services Administration. For additional information on immunizations, visit the immunization schedule section of www.cdc.gov. This document is a general guide. Always
discuss your particular preventive care needs with your doctor.
Some plans choose to supplement the preventive care services listed above with a few additional services, such as other common laboratory panel tests. When delivered during a preventive care
visit, these services also may be covered at the preventive level.
Exclusions
This document provides highlights of preventive care coverage generally. Some preventive services may not be covered under your plan. For example, immunizations for travel are generally not covered.
Other non-covered services/supplies may include any service or device that is not medically necessary or services/supplies that are unproven (experimental or investigational). For the specific coverage
terms of your plan, refer to the Evidence of Coverage, Summary Plan Description or Insurance Certificate.
Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of
coverage, review your plan documents or contact a Cigna Healthcare representative.
All Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company (CHLIC), Connecticut
General Life Insurance Company, Evernorth Care Solutions, Inc., Evernorth Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation, including Cigna HealthCare
of Arizona, Inc., Cigna HealthCare of California, Inc., Cigna HealthCare of Colorado, Inc., Cigna HealthCare of Connecticut, Inc., Cigna HealthCare of Florida, Inc., Cigna HealthCare of Georgia, Inc., Cigna
HealthCare of Illinois, Inc., Cigna HealthCare of Indiana, Inc., Cigna HealthCare of St. Louis, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of New Jersey, Inc., Cigna HealthCare of South
Carolina, Inc., Cigna HealthCare of Tennessee, Inc. (CHC-TN), and Cigna HealthCare of Texas, Inc. Policy forms: OK - HP-APP-1 et al., OR - HP-POL38 02-13, OR - HP-POL3812-13 TN - HP-POL43/HC-
CER1V1 et al. (CHLIC); GSA-COVER, et al. (CHC-TN). The Cigna Healthcare name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
855050 s 05/24 © 2024 Cigna Healthcare. Some content provided under license.