Health Insurance

100% Covered

Provider

Blue Cross and Blue Shield of Nebraska

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Group #101498
NEtwork BLUE Network
1-888-592-8961

Pharmacy Network

Network C

Drug List

PDL 10 (Formerly “BCBSNE Standard Formulary“)

WoodmenLife Associates at the Gym

Preventive Care Services

Preventive care services are covered at 100% when they are obtained from a network provider, as long as no diagnosis is made. Please see the chart below for more information on recommended preventive care services.

The services listed are general recommendations. Your doctor may recommend different frequency or timing based on your personal or family history.

History, Physical Examination and Assessment At each preventive care visit
Blood Pressure
Height and Weight (BMI)
Depression Screening
Tobacco, Alcohol or Drug Abuse Screening
Sexual Wellness and Disease Screening
Diabetes Screening At each preventive care visit
Cholesterol Screening Every five years beginning at age 35
Colorectal Cancer Screening 50 years of age and over; annually with fecal occult blood test; every 5-10 years with colonoscopy
Cervical Cancer Screening (Pap smear) Women annually at age 18 or age of sexual activity and every 1-3 years thereafter
Breast Cancer Screening (Mammogram) Women age 40 and older; every 1-2 years thereafter
Osteoprorosis Screening Age 65 and older; once every two years thereafter
Sexually Transmitted Disease Screening Annually based on risk
Pregnancy-related Screenings Ask your doctor about additional services recommended during your pregnancy
Bacteria in the urine
Folic acid supplementation
Hepatitis B screening
Rh compatibility
Iron deficiency screening
Gestational diabetes
Risk of Falling Assessment Age 65 and older

Immunizations

Tetanus and Diphtheria (Td/Tdap) Every 10 years
Pneumococcal (Pneumonia) One dose
Influenza (flu) Annually
Human Papilloma Virus (HPV) 3-dose series before age 25
Zoster (Shingles) One dose, age 60 or over
Meningococcal Certain high risk groups based on medical, occupational, lifestyle, or other indicators
Hepatitis B or Hepatitis A Persons at risk or catch-up series
Varcella (Chicken pox) Catch-up if needed

Other Services

Breastfeeding Support, Supplies, and Counseling One breast pump per pregnancy
Contraceptive Methods and Counseling Varies based on contraceptive methods
Diet Counseling 100% paid as needed