Covered Preventive Care Services

TRS Plans Pay 100% When Using In-Network Providers

Updated September 2022

We encourage you to take full advantage of your health benefits by using your preventive care services. Preventive care refers to routine health check-ups and screenings for common diseases that can help you avoid further health issues and increased costs down the road.

TRS plans will pay 100% of in-network office visits and lab tests for preventive care. Preventive services from an out-of-network provider are subject to any applicable deductible and coinsurance.

Coverage of preventive services and screenings are based off recommendations from the United States Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention (CDC). TRS also considered additional preventive services for infants, children, adolescents and women based off recommendations from the Health Resources and Services Administration (HRSA).

Know the Difference: Preventive vs. Diagnostic

It’s important to know the difference between preventive and diagnostic care. Diagnostic care refers to the diagnosis, treatment and monitoring of a disease or condition. If your visit results in the diagnosis of a condition or treatment of an existing condition, this service is diagnostic.

Preventive Care Service

You have a screening done within the recommended timeframe (i.e. annual mammogram) with normal findings.
You have diagnostic service results that were normal and future preventive screenings follow the recommended preventive services timeframe.
You have a preventive care service done that results in a therapeutic service that your physician requires be done at the same medical visit but does not result in a diagnosis.

Diagnostic Care Service

You have abnormalities found on a current or previous preventive or diagnostic care service that requires further diagnostic services or a repeat of the same service within a shortened timeframe.
You have a symptom(s) that required further diagnosis.

Preventive care services may change as USPSTF, CDC and HRSA guidelines are modified.

The chart below shows a list of common covered preventive services. The following list is for quick reference only, is not an exhaustive list, and is based on the more detailed clinical best practice guidelines.

If you have additional questions about what preventive services are covered based on your demographics, please refer to your benefits booklet or contact your health plan.

List of Covered Preventive Care and Screenings
Adults
Women
Contraceptive counseling and administration of contraceptives Osteoporosis screening age 65 and older, or younger based on risk Chlamydia infection screening Gonorrhea and syphilis screening HPV and pap smear screening every three years for ages 30+
Pregnant Women
Folic acid supplements Anemia screening for iron deficiency Tobacco cessation counseling Syphilis screening Hepatitis B screening Rh incompatibility blood type testing Bacteriuria urinary tract infection screening Breastfeeding support, services, supplies limited to 6 lactation counseling visits per plan year. Gestational diabetes for certain pregnant women Depression Preeclampsia in certain women
Men
Abdominal aortic aneurysm one-time screening in men ages 65 to 75 years who have ever smoked Osteoporosis screening age 70+, or younger, based on medical necessity
Cancer screenings
Breast cancer mammography for women age 35+, or younger, based on increased risk factors , once per plan year BRCA counseling about genetic testing (precertification required) Cervical cancer screening including cervical dysplasia screening and pap test for women 18 and over Colorectal cancer screenings including fecal occult blood testing, double contrast barium enema, sigmoidoscopy or colonoscopy, for adults 45+ once every 10 years Prostate cancer (PSA) screening for men age 40+ if high risk. Otherwise, covered for 45+, once per plan year
TRS-Care Medicare Advantage Participants Only
Annual routine physical exam for participants with Medicare Part B “Welcome to Medicare” one-time preventive visit for new participants Annual glaucoma screening Cardiovascular testing every five years Annual lung cancer screening Diabetes self-monitoring training Kidney disease education services Medical nutrition therapy

List of Covered Preventive Care and Screenings
Adults
General Health Visits and Screenings
Annual wellness visit Cholesterol screening Type 2 diabetes screening HIV and sexually transmitted infections (STIs) screenings Hypertension screening
Health Counseling
Doctors are encouraged to counsel patients about these health issues and refer them to appropriate resources as needed: Healthy diet/obesity counseling for ages 22+, limited to 26 visits per 12 months. Up to 10 visits used for healthy diet counseling. Weight loss Smoking cessation counseling, limited to 8 visits per 12 months. Alcohol misuse Depression Prevention of sexually transmitted infections (STIs) Use of aspirin to prevent cardiovascular disease
Immunizations
Hepatitis A and B Herpes Zoster (Shingles ) (once per lifetime for TRS-Care Standard) Human Papillomavirus (HPV) Influenza (Flu) Measles, Mumps, Rubella Meningococcal Pneumococcal (pneumonia) Tetanus, Diphtheria, Pertussis Varicella (chickenpox)

List of Covered Preventive Care and Screenings
Children and Adolescents
Newborns
Screening for hearing loss (TRS-ActiveCare only) Hypothyroidism Sickle cell disease Phenylketonuria (PKU) Gonorrhea Preventive medication for eyes
Immunizations
Diphtheria, Tetanus, Pertussis Haemophilus influenzae type B Hepatitis A and B Human Papillomavirus(HPV) Influenza (Flu) Measles, Mumps, Rubella Meningococcal Pneumococcal (Pneumonia) Inactivated Poliovirus Rotavirus Varicella (Chickenpox)
Childhood health screenings
Medical history for all Children throughout development Height, weight and Body Mass Index (BMI) measurements Developmental screening Autism screening Behavioral assessment Vision screening to detect amblyopia or risk factors Oral health risk assessment Hematocrit or hemoglobin screening Obesity screening and Weight management counseling Iron supplements Fluoride supplements Lead screening Dyslipidemia screening Tuberculin testing
Adolescent health screenings
Depression screening Alcohol and drug use assessment Counseling to prevent sexually transmitted infections (STIs) HIV screening