Download Women`s Preventive Services

HEALTH CARE REFORM UPDATE:
Women’s Preventive Services
Prevention is your best defense against disease. Coventry Health Care’s plans routinely cover exams and
screenings that prevent and identify early certain medical conditions. Most of our plans also cover prescription drugs used for
treatment. In keeping with the Affordable Care Act (ACA), Coventry Health Care expanded these services to make it even easier
for women to receive care.
Most fully insured Coventry plans that are not “grandfathered” cover certain preventive care services for women without cost
sharing. Most self-funded plans are required to offer similar coverage without cost sharing. (If you are uncertain whether your plan
is fully insured, self-funded or “grandfathered,” check with your employer.)
Coverage without cost sharing means women can receive certain preventive
services without having to pay a deductible, coinsurance or copayment. These
services are listed below:
n Well-woman visits (including prenatal visits)
n Screening for gestational diabetes
n Human papillomavirus (HPV) DNA testing for women 30 years and older
n Risk-reducing medications, such as tamoxifen and raloxifene, for women
35 years and older who have an increased risk for breast cancer.
n Sexually transmitted infection counseling
n Human immunodeficiency virus (HIV) screening and counseling
n FDA-approved contraception methods and contraceptive counseling (subject
to standard medical management and formulary restrictions).*
n Breastfeeding support, supplies (manual or standard electric pumps) and
counseling
n Domestic violence screening and counseling
To be covered with no additional cost sharing, these services must be done by
in-network physicians.
OVER-THE-COUNTER FEMALE CONTRACEPTIVES
Over-the-counter female contraceptives will be covered with no cost sharing for
members ONLY with a prescription.
Some Facts about the
Benefits of Women’s
Preventive Services
■ The Centers for Disease
Control and Prevention (CDC)
states that most cervical
cancers are preventable with
regular screenings and followup treatment. They are also
very curable when found early.
■ HPV DNA testing can detect
the presence of high-risk HPV
strains in cervical cells, which
can lead to cervical cancer,
according to the CDC.
Source: http://www.cdc.gov/Features/
CervicalCancer/
Please note: For all other employer groups, Coventry will cover most contraceptive
prescriptions with no cost share. However, there are some contraceptive
prescriptions for which members will have to pay a deductible, copayment or
coinsurance. To minimize your out-of-pocket pharmacy costs, check the next page for a list of contraceptive prescriptions that
Coventry covers with no cost sharing.
If you have any questions about the coverage for women’s preventive services, please call the number on your ID card. We also
encourage you to visit our corporate website at www.cvty.com to stay abreast of changes resulting from health care reform.
*Certain religious employers that offer insurance to their employees are not
required to cover contraceptive services.
©2015 Coventry Health Care, Inc. All rights reserved.
WOM.PREV.UPD.MEM.0615
Contraceptives Covered Under
Women’s Preventive Services
Coventry will cover the contraceptive prescriptions listed below with no cost sharing for members receiving these drugs or devices for
the prevention of conception. Contraceptives not on this list will be covered at the applicable member cost share. (Please note: This
list is subject to change.)
Altavera
Alyacen
Amethia/Lo
Amethyst
Apri
Aranelle
Aubra
Aviane
Azurette
Balziva
Briellyn
Camila
Camrese/Lo
Caziant
Chateal
Cryselle
Cyclafem
Dasetta
Daysee
Deblitane
Delyla
Desogestrel/ethinyl/estra
Drospirenone-Ethinyl Estradiol
Elinest
Ella
Emoquette
Enpresse
Enskyce
Errin
Estarylla
Falmina
Femcap
Gianvi
Gildagia
Gildess/Fe
Gynol
Heather
Implanon^
Introvale
Jencycla
Jolivette
Junel
Junel Fe
Kariva
Kelnor 1-35
Kurvelo
Larin/Fe
Leena
Lessina
Levonest
Levonorgestrel
Levonorgestrel-Eth-Estradiol
Levora
Loryna
Low-Ogestrel
Lutera
Lyza
Marlissa
Medroxyprogesterone vial 150mg
Microgestin/Fe
Mirena^
Mono-Linyah
Mononessa
Myzilra
Necon 1/35
Nexplanon^
Next Choice
Nikki
Nora-Be
Norethindrone Acetate
Norgestimate-Ethiny-Estradiol
Norgestrel-Ethinyl-Estradiol
Norlyroc
Nortrel 1/35
Nuvaring
Ocella
Ogestrel
Orsythia
Ortho-Diaphragm
Paragard T 380-A^
Philith
Pirmella
Plan B
Plan B One-Step
Portia
Previfem
Quasense
Reclipsen
Sharobel
Skyla^
Solia
Sprintec
Sronyx
Syeda
Tilia Fe
Today Contraceptive Sponge
Tri-Estarylla
Tri-Legest Fe
Tri-Linyah
Tri-Previfem
Tri-Sprintec
TriNessa
Trivora
VCF
Velivet
Vestura
Viorele
Vyfemla
Wera
Wide Seal Diaphragm
Wymzya Fe
Xulane
Zarah
Zenchent/Fe
Zovia
^May be covered under your medical benefit. Please refer to your health plan documents.
Contraceptives Covered Under
Women’s Preventive Services
This plan does not cover all health care expenses and includes exclusions and limitations. Members should refer to their plan
documents to determine which health care services are covered and to what extent. The following is a partial list of services and
supplies that are generally not covered. However, your plan documents may contain exceptions to this list based on the plan design or
rider(s) purchased.
• A ll medical and hospital services not specifically covered in, or which are limited or excluded by your plan documents, including
costs of services before coverage begins and after coverage terminates.
• Cosmetic surgery.
• Custodial care.
• Dental care and dental x-rays.
• Donor egg retrieval.
• Durable medical equipment.
• Experimental and investigational procedures, (except for coverage for medically necessary routine patient care costs for Members
participating in a cancer clinical trial).
• Hearing aids.
• Home births.
• Immunizations for travel or work.
• Implantable drugs and certain injectable drugs including injectable infertility drugs.
• Infertility services including, but not limited to, artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT,
ICSI and other related services unless specifically listed as covered in your plan documents.
• Nonmedically necessary services or supplies.
• Orthotics except diabetic orthotics.
• Outpatient prescription drugs (except for treatment of diabetes), unless covered by a prescription plan rider and over-the-counter
medications (except as provided in a hospital) and supplies.
• Radial keratotomy or related procedures.
• Reversal of sterilization.
• Services for the treatment of sexual dysfunction or inadequacies including therapy, supplies or counseling.
• Special duty nursing.
• Therapy or rehabilitation other than those listed as covered in the plan documents.
• Weight control services including surgical procedures, medical treatments, weight control/loss programs, dietary regimens and
supplements, appetite suppressants and other medications; food or food supplements, exercise programs, exercise or other
equipment; and other services and supplies that are primarily intended to control weight or treat obesity, including Morbid Obesity,
or for the purpose of weight reduction, regardless of the existence of comorbid conditions.