IQVIA Benefits Handbook
PREVENTIVE CARE
The Medical Plan uses prevailing clinical standards to determine preventive care guidelines. The plan covers preventive care services, which include:
Well Child Care
These services are covered for each covered child through age two including periodic assessments and immunizations.
Women's Preventive Health Care
Women's preventive health care is covered at 100%, including oral contraceptives (generic and brand name), contraceptive devices and implants.
Routine Physical Exams
Routine physical exams, health care assessments, wellness visits and any related services will be covered for each covered individual age three and older (including immunizations). A routine physical exam is a medical exam given by a physician for a reason other than to diagnose or treat a suspected or identified illness or injury, and also includes radiological services and X-rays.
Immunizations
The full series of standard immunizations recommended by the Department of Health. Covered immunizations include, but are not limited to, the following:
  • Diphtheria Pertussis Tetanus Toxoid (DPT).
  • HiB.
  • Polio.
  • Hepatitis A and B.
  • Measles Mumps Rubella (MMR).
  • Meningococcal vaccine.
  • Chicken pox.
  • Pneumococcal vaccine.
  • Rotavirus.
  • Human papillomavirus.
  • Flu vaccines.
Cancer Screenings
Covered expenses include charges incurred for routine cancer screenings and related office visits.
  • Gynecological exam, including cervical cancer screening: The cervical cancer screening benefit includes an exam and laboratory tests for early detection and screening of cervical cancer, and the doctor's interpretation of the lab results. Coverage for cervical cancer screening includes a Pap smear screening, liquid based cytology and human papilloma virus detection and should follow the American Cancer Society guidelines.
  • Screening mammograms: Screening mammograms are covered along with a doctor's interpretation of the results. In the Aetna plans, the first mammogram in a calendar year will be covered at 100% by the plan. All subsequent mammograms in a calendar year are subject to the applicable plan provisions.
  • Prostate screening: Prostate Specific Antigen (PSA) tests or equivalent serological tests are covered.
  • Colorectal cancer screenings including:
    • Fecal occult blood test (including a digital rectal examination (DRE)).
    • Flexible sigmoidoscopy (including a DRE).
    • Fecal occult blood test plus flexible sigmoidoscopy (including a DRE).
    • Double contrast barium enema (including a DRE).
    • Colonoscopy (including a DRE).
    • Lung cancer screenings.
  • Skin cancer screenings and other standard cancer screenings.
Additional Services
  • Obesity or health diet counseling: Preventive counseling visits, nutritional counseling, healthy diet counseling visits for members with high cholesterol. For members 22 and older, the maximum annual visits is 26 with no more than 10 visits for healthy diet counseling. There is no visit limit for members under age 22.
  • Screening for misuse of alcohol or drugs: Preventive counseling visits, risk factor reduction intervention and a structured assessment. Maximum of five (5) visits per member per year. A 60-minute session is equal to one visit.
  • Screening for use of tobacco products: Preventive counseling visits, treatment visits and class visits. When prescribed by a physician FDA- approved prescription drugs and over the counter drugs to help stop the use of tobacco products.
  • Sexually transmitted infection counseling: Eligible services include counseling services to help you prevent or reduce sexually transmitted infections.
  • Genetic risk of counseling for breast and ovarian cancer: Eligible services include the counseling and evaluation services to help you assess whether or not you are at increased risk for breast and ovarian cancer.
  • Lactation support and counseling services: Eligible services include assistance and training in breastfeeding from a certified lactation support provider.
  • Breast pump: The purchase of an electric breast pump once every three years or the purchase of a manual breast pump once per pregnancy.