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Preventive Care Services and Guidelines

Blue Cross of Idaho provides benefits for in-network preventive services if it is an evidence-based service or it has an A or B rating from the United States Preventive Services Task Force and the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and Health Resources and Services Administration.

  • Blue Cross of Idaho adopts evidenced-based preventive health guidelines in an effort to improve healthcare quality and reduce unnecessary variation in care.
  • We encourage the appropriate use of preventive services to our members according to age, gender, and risk-status. These include screenings, immunizations, and physical examinations.
  • Our Physician Advisory Panel reviews and approves our preventive standards no less than every two years or if there are significant changes.

Blue Cross of Idaho continually updates its list of preventive services covered under qualified health plans (QHP) and metallic plans purchased from the online healthcare exchange.

If you are on a Grandfathered Plan, please refer to your Enrollee Certificate for Preventive/Wellness Benefits

Blue Cross of Idaho used the guidelines below to create our list of covered prevented services.

Perinatal Care

Sources: U.S. Preventive Services Task Force
United States of America, Affordable Care Act Webpage

0 to 24 Months

Sources: U.S. Preventive Services Task Force
United States of America, Affordable Care Act Webpage

2 - 19 Years

Sources: U.S. Preventive Services Task Force
United States of America, Affordable Care Act Webpage

20 to 64 Years

Sources: U.S. Preventive Services Task Force
United States of America, Affordable Care Act Webpage

65+ Years

Sources: U.S. Preventive Services Task Force
United States of America, Affordable Care Act Webpage

All ages - Immunizations

Sources: Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices
United States of America, Affordable Care Act Webpage

NOTE:

Preventive services do not generally include services intended to treat an existing illness, injury, or condition. Benefits will be determined based on how the practitioner submits the bill. Claims must be submitted with the appropriate diagnosis and procedure code in order to be paid at the 100% benefit level. If during your preventive services visit you receive services to treat an existing illness, injury or condition, you may be required to pay a copay, deductible, and or coinsurance for those covered services.

EFFECTIVE 10/1/2013