Preventive services

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How to know if this information applies to your plan

This preventive services information applies to nongrandfathered, non-retiree-only individual and group plans that cover preventive services at no extra cost.¹ It doesn’t apply to Medicare or grandfathered retiree-only plans.

Refer to your Evidence of Coverage or other coverage documents for details about your plan’s coverage. If you have a group plan, you can also talk to your employer’s benefits administrator.

Updates for 2024

The following are benefit changes for 2024, as required by the Affordable Care Act (ACA). Most of our plans will now cover the following services for plan years or policy years beginning on or after January 1, 2024:

• Anxiety screening in adults
• Vaccines and immunizing agents to protect against serious illness from respiratory syncytial virus (RSV) for adults, infants, and older babies at high risk 
  

Preventive services for adults

• Abdominal aortic aneurysm screening for men 65 to 75 who have ever smoked (one-time screening)
• Alcohol misuse screening and counseling
• Annual lung cancer screening with low-dose computed tomography and counseling for adults 50 to 80 who are at high risk based on their current or past smoking history
• Anxiety screening for adults (will be covered for plan years or policy years beginning on or after January 1, 2024)
• Behavioral counseling interventions to promote a healthy diet and physical activity for adults with cardiovascular risk factors
• Behavioral counseling for sexually active adults who are at increased risk for sexually transmitted infections
• Behavioral counseling interventions for tobacco use and cessation
• Blood pressure screening
• Colon cancer screening for adults 45 to 75, including:    
  • Preconsultation
  • Bowel preparation
  • Pathology exam on a polyp biopsy
• Depression screening
• FDA-approved medications for tobacco cessation, including over-the-counter medications, when prescribed by a Plan provider
• FDA-approved preexposure prophylaxis (PrEP) with effective antiretroviral therapy for people at high risk for HIV, when prescribed by a Plan provider. Includes the following baseline and monitoring services for the use of PrEP:
  • HIV testing
  • Hepatitis B and C testing
  • Creatinine testing and calculated estimated creatine clearance (eCrCl) or glomerular filtration rate (eGFR)
  • Pregnancy testing
  • Sexually transmitted infection (STI) screening and counseling
  • Adherence counseling
• Hemoglobin A1c testing for diabetes³
• Hepatitis B screening for adults at higher risk
• Hepatitis C screening for adults 18 to 79
• Immunizations (doses, recommended ages, and recommended populations vary):
  • COVID-19
  • Hepatitis A
  • Hepatitis B
  • Herpes zoster
  • Human papillomavirus
  • Influenza
  • Measles, mumps, rubella
  • Meningococcal (meningitis)
  • Pneumococcal
  • Respiratory syncytial virus (RSV) (will be covered for plan years or policy years beginning on or after January 1, 2024)
  • Tetanus, diphtheria, pertussis
  • Varicella
• International normalized ratio (INR) testing for liver disease and/or bleeding disorders³
• Latent tuberculosis infection screening
• Low-density lipoprotein (LDL) testing for heart disease³
• Low-dose aspirin use for the prevention of cardiovascular disease or colorectal cancer when prescribed by a Plan provider⁴
• Obesity and weight management, including intensive behavioral counseling for overweight adults with a BMI of 30 or higher
• Physical therapy to prevent falls in community-dwelling adults 65 and older who are at increased risk of falling
• Prediabetes and diabetes screening (type 2) for adults 35 to 70 who are overweight or obese
• Prostate cancer screening⁵ 
• Retinopathy screening for diabetes³
• Routine physical exam
• Sexually transmitted infection screenings for adults at higher risk
  • Chlamydia
  • Gonorrhea
  • HIV
  • Syphilis
• Statin use for the primary prevention of cardiovascular disease in adults 40 to 75 with no history of cardiovascular disease (CVD), one or more CVD risk factors, and a calculated 10-year CVD event risk of 10% or greater, when prescribed by a Plan provider
• Unhealthy drug use screening
• Universal lipids screening in adults 40 to 75 to identify dyslipidemia and a calculation of a 10-year CVD risk

Additional preventive services for women and pregnant people⁶

• Anemia screening for pregnant people⁷ 
• Anxiety screening for adolescent and adult women
• Bacteriuria screening in asymptomatic pregnant people
• Behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy
• Behavioral counseling interventions for tobacco use and cessation for pregnant people
• BRCA genetic counseling to assess risk of carrying breast or ovarian cancer genes
• BRCA genetic testing for high-risk women and when services are ordered by a Plan physician
• Breast cancer screening for average-risk women
• Breastfeeding equipment and supplies:
  • Retail-grade double-electric breastfeeding pump, including any equipment that’s required for pump functionality
  • Breast milk storage supplies and other equipment/supplies as clinically indicated to support dyads with breastfeeding difficulties
• Cervical cancer screening for adolescents and women 21 to 65
• Comprehensive lactation support and counseling before and after childbirth
• Contraceptive devices, methods, and drugs (FDA-approved and prescribed by your doctor), contraceptive device removal, and female sterilizations
• Contraceptive counseling, education, and follow-up care
• Counseling intervention for pregnant or postpartum people at increased risk of perinatal depression
• Folic acid for people who are capable of pregnancy, when prescribed by a Plan provider
• FDA-approved medications for tobacco cessation for pregnant people, including over-the-counter medications, when prescribed by a Plan provider⁸
• Hepatitis B screening for pregnant people at their first prenatal visit
• HIV screening for pregnant people
• Low-dose aspirin after 12 weeks of gestation for people who are at high risk for preeclampsia, when prescribed by a Plan provider
• Medication for breast cancer prevention for women 35 and older at increased risk, when prescribed by a Plan provider
• Obesity prevention counseling for women in midlife 
• Osteoporosis screening for women 65 and older and those at higher risk
• Perinatal depression screening for pregnant and postpartum people
• Postpartum visits 
• Preeclampsia screening for pregnant people with blood pressure measurements during pregnancy
• Rh(D) blood typing and antibody testing for pregnant people
• Routine physical exam
• Routine prenatal care visits⁹
• Screening and counseling for interpersonal and domestic violence
• Screening for diabetes in pregnancy
• Screening for diabetes after pregnancy
• Screening for urinary incontinence in women
• Syphilis screening for pregnant people

Preventive services for children

• Age-appropriate routine physical exams
• Anxiety screening in children and adolescents 8 to 18
• Autism spectrum disorder screening at 18 months and 24 months
• Behavioral counseling for sexually active adolescents who are at increased risk for sexually transmitted infections
• Behavioral/social/emotional screening throughout development
• Blood pressure screening for adolescents
• Congenital hypothyroidism screening for newborns
• Depression screening for adolescents 12 to 21
• Developmental screening and surveillance throughout infancy, childhood, and adolescence
• Dyslipidemia screening for children at higher risk of lipid disorders
• FDA-approved medications for tobacco cessation, including over-the-counter medications, when prescribed by a Plan provider
• FDA-approved preexposure prophylaxis (PrEP) with effective antiretroviral therapy for adolescents at high risk for HIV, when prescribed by a Plan provider). Includes the following baseline and monitoring services for the use of PrEP:
  • HIV testing
  • Hepatitis B and C testing
  • Creatinine testing and calculated estimated creatine clearance (eCrCl) or glomerular filtration rate (eGFR)
  • Pregnancy testing
  • Sexually transmitted infection (STI) screening and counseling
  • Adherence counseling
• Gonorrhea prevention medication for the eyes for newborns
• Height, weight, and body mass index (BMI) measurements throughout development
• Hepatitis B screening for adolescents at higher risk
• HIV screening for adolescents at higher risk
• Immunizations from birth to 18. Doses, recommended ages, and recommended populations vary:
  • COVID-19
  • Diphtheria, tetanus, pertussis
  • Haemophilus influenzae type B
  • Hepatitis A
  • Hepatitis B
  • Human papillomavirus
  • Inactivated poliovirus
  • Influenza
  • Measles, mumps, rubella
  • Meningococcal (meningitis)
  • Pneumococcal
  • Respiratory syncytial virus (RSV) (will be covered for plan years or policy years beginning on or after January 1, 2024)
  • Rotavirus
  • Varicella
• Iron supplements for asymptomatic children 6 to 12 months at increased risk for iron deficiency anemia, when prescribed by a Plan provider¹⁰
• Lead screening for children at risk of exposure
• Medical history throughout development
• Newborn blood screenings, including bilirubin testing and sickle cell screening
• Obesity screening and counseling
• Oral health risk assessments by primary care doctor for children younger than 5:
  • Fluoride supplementation starting at 6 months for children whose water supply is deficient in fluoride
  • Fluoride varnish for the primary teeth of all infants and children starting at the age of primary tooth eruption
• Phenylketonuria screening for newborns
• Routine hearing screening
• Skin cancer counseling for young adults, adolescents, children, and parents of young children about minimizing exposure to ultraviolet radiation for people 6 months to 24 with fair skin types to reduce their risk of skin cancer
• Sudden cardiac arrest and sudden cardiac death risk assessment
• Suicide risk assessment as an element of universal depression screening for people 12 to 21
• Tobacco, alcohol, or drug use assessment for people 11 to 21
• Tuberculin testing for children at higher risk of tuberculosis
• Vision screening

Additional area-specific preventive services¹¹

For health plans issued in one of the following states, additional area-specific preventive services are also listed.

California

• All contraceptive methods approved by the Food and Drug Administration (FDA) and obtained from a Plan Pharmacy, including items available over-the-counter or prescribed by a Plan provider, for all members regardless of gender.
• Vasectomy services and procedures (will be covered for plan years or policy years beginning on or after January 1, 2024)
• Clinical services related to contraception including, but not limited to, consultations, examinations, procedures, ultrasounds, and referrals.
• Retinal photography screenings for adults and children
• Travel immunizations
• Vision refraction exams for adults and children¹²

Colorado

• Breast cancer screening for all at-risk people regardless of age
• Contraception dispensed or furnished for 12 months as permitted by the member’s prescription.
• Mental health wellness exam¹³
• Colon cancer screening for all at-risk people regardless of age
• Post-mammogram breast imaging services prior to biopsy/cancer diagnosis

Georgia

• Medically necessary labs and X-rays associated with a well-child visit
• Ovarian cancer surveillance test for women over 35 or at risk

Maryland

• Labs and X-rays associated with well-child visits

Oregon

• Screening and medically necessary services and prescription medications for the treatment of physical, mental, sexual, and reproductive health care needs that arise from a sexual assault
• Voluntary male sterilizations

Virginia

• Labs and X-rays associated with well-child visit

Washington — Southwest region

• Screening and medically necessary services and prescription medications for the treatment of physical, mental, sexual, and reproductive health care needs that arise from a sexual assault
• Voluntary male sterilizations

Washington, D.C.

• Adjuvant breast screening (follow-up breast MRI or ultrasound for women with dense breast tissue, after an inconclusive mammogram, or deemed high risk by their provider)
• Labs and X-rays associated with well-child visits

Disclaimers
[1] The preventive services described above also apply to all grandfathered and retiree-only large group plans that cover these services at no additional cost and all grandfathered small group plans in the state of California.
[2] Grandfathered plans are plans that have been in existence since, on, or before March 23, 2010, and that meet certain requirements. Grandfathered plans are exempt from some of the changes required under the Affordable Care Act, including those related to preventive services, and may have a cost share associated with these services. If a member is enrolled in a grandfathered plan, this will be stated in their Evidence of Coverage or other coverage documents. Also, grandfathered plans may not cover all services listed in this document, such as over-the-counter drugs. Members enrolled in grandfathered plans can also contact our Member Services at 1-800-464-4000 (TTY 711), 24 hours a day, 7 days a week (closed holidays), for information about their plan’s coverage of specific preventive care services.
[3] On July 17, 2019, the Internal Revenue Service (IRS) and U.S. Treasury Department issued Notice 2019-45, which expands the list of preventive care benefits permitted to be provided without satisfying the deductible of a high deductible health plan (HDHP) under section 223(c)(2) of the Internal Revenue Code. Kaiser Permanente made the decision to add all these lab tests and screenings for specific chronic conditions allowed by IRS Notice 2019-45 to Kaiser Permanente’s National Preventive Care package, effective all at once, on January 1, 2021. Self-Funded Plans may not have agreed to this expansion, please see your Summary Plan Description or other plan documents.
[4] In April 2022, the U.S. Preventive Services Task Force determined that the decision to initiate low-dose aspirin use for the primary prevention of cardiovascular disease in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one. The U.S. Preventive Services Task Force also concluded there is inadequate evidence to support low-dose aspirin use reduces colorectal cancer incidence or mortality. Despite this determination, Kaiser Permanente will continue to cover this service as preventive. Self-Funded Plans may not have agreed to this expansion, please see your Summary Plan Description or other plan documents.
[5] The U.S. Preventive Services Task Force recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small. Despite this determination, prostate cancer screening is a part of Kaiser Permanente’s Preventive Care package, effective January 1, 2023. Self-Funded Plans may not have agreed to this expansion, please see your Summary Plan Description or other plan documents.
[6] Breast pumps and certain over-the-counter drugs may not be covered in plans that do not include an ACA preventive package (see your Evidence of Coverage or other coverage documents).
[7] In September 2015, the U.S. Preventive Services Task Force determined that current evidence is insufficient to assess the balance of benefits and harms of screening of iron deficiency in pregnant people to prevent adverse maternal health and birth outcomes. Despite this determination, Kaiser Permanente will continue to cover this service as preventive. Self-Funded Plans may not have agreed to this expansion, please see your Summary Plan Description or other plan documents.
[8] In September 2015, the U.S. Preventive Services Task Force determined that current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant people. Despite this determination, Kaiser Permanente will continue to cover this service as preventive. Self-Funded Plans may not have agreed to this expansion, please see your Summary Plan Description or other plan documents.
[9] Prenatal services are covered as routine base medical services that are included in global billing for maternity services, which may be subject to cost sharing, as permitted by applicable law.
[10] In September 2015, the U.S. Preventive Services Task Force determined that current evidence is insufficient to assess the balance of benefits and harms of screening for iron deficiency anemia in children ages 6 to 24 months. The U.S. Preventive Services Task Force also determined that given the current widespread use of iron-fortified foods in the United States (including infant formulas and cereals), the impact of making a recommendation on physician-prescribed supplementation is likely limited. Despite this determination, Kaiser Permanente will continue to cover iron supplements as preventive. Self-Funded Plans may not have agreed to this expansion, please see your Summary Plan Description or other plan documents.
[11] Most self-funded groups are not subject to state mandates. For more information on preventive services, call Member Services or see your Summary Plan Description or other plan documents.
[12] Vision refraction services may or may not be subject to an HSA-qualified HDHP deductible. If the service is subject to the deductible on an HSA-qualified HDHP plan, it may be subject to a copay or coinsurance after the deductible has been met.
[13] Effective January 1, 2023, health plans must cover an annual mental wellness checkup for all individuals regardless of age. The applicable cost share for this service may apply to grandfathered plans.

The required preventive services are based on recommendations by the U.S. Preventive Services Task Force, Health Resources & Services Administration, and the Centers for Disease Control and Prevention. The services listed in this document may be subject to certain guidelines, such as age and frequency. They may be subject to a copay or coinsurance if they are not provided in accord with these guidelines.