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Preventive Care is
important to your health

Health Benefits & Coverage

Preventive Care Services for Women

The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan. Take advantage of preventive care and stop problems before they get serious.

To be covered with no out-of-pocket costs, the service must be:

  • Provided by an in-network doctor or facility (urgent care facility, outpatient clinic or ambulatory surgery center)
  • Filed by your doctor as a preventive care visit
  • Identified as preventive care under the Affordable Care Act (ACA)

100% Covered Services for Women

The age and frequency listed below are general recommendations.
Talk to your doctor to find out which of these you should have based on your health.

Click on a service to see any limits or exclusions.

Cancer screenings and counseling

Additional services for women at high risk for breast cancer

Disease prevention and heart health

Pregnancy and childbirth

Sexual health

Mental health and substance use

Nutrition and wellness


The following are the recommended vaccines for women that are covered with no out of pocket cost. Doses, recommended ages and recommended populations vary.

See your doctor and refer to the CDC’s posted schedule of immunizations for more information.

  • Haemophilus influenza type b
  • Herpes Zoster (Shingles)1
  • Hepatitis A
  • Hepatitis B
  • Human papillomavirus (HPV)2
  • Influenza (Flu)
  • Measles, mumps, rubella (MMR)
  • Meningococcal
  • Pneumonia
  • Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap)
  • Varicella (Chicken Pox)

1 If you have gotten one dose of Zostavax vaccine for shingles, you should also get the two doses of Shingrix vaccine.

2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines.


List of all medications that are covered at 100% on Enhanced, Essential or NetResults formularies

The Affordable Care Act (ACA) has identified certain services as preventive care to be paid at 100%.

  • These benefits are available for members of non-grandfathered individual health insurance plans.
  • If you get benefits from your employer, you may also have these benefits. If your Summary of Benefits section of your Benefit Booklet contains PREVENTIVE CARE covered under federal law, then you have these benefits at no charge IN-NETWORK.
  • These benefits are currently in effect unless otherwise noted.
  • Check your Benefit Booklet for details on other preventive care benefits.
  • This information is a reference tool and does not guarantee payment of any claims.
  • For transgendered individuals, you have access to medically appropriate preventive services.

Still have questions?

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