Blue Cross and Blue Shield of Nebraska
Group #: 101498
NEtwork BLUE Network
Pharmacy Network: Network C
Drug List: PDL 10 (Formerly "BCBSNE Standard Formulary")
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|
|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|
|Risk of Falling Assessment||Age 65 and older|
|Tetanus and Diphtheria (Td/Tdap)||Every 10 years|
|Pneumococcal (Pneumonia)||One dose|
|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|
|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|
The information on this page is a partial description of benefits, limitations, exclusions, and other provisions of the group benefits provided by Woodmen of the World Life Insurance Society (WoodmenLife). If there is a difference between the information in this summary and the plan document for each plan, the plan documents govern. Eligibility requirements apply to each of the benefits offered, criteria may include employment status and/or individual qualifications. For more detailed information, refer to the Summary Plan Description of each plan. WoodmenLife may amend these plans at any time. The description of the plan is not a guarantee of benefits and should not be construed as such.
This is the Life is a registered service mark of Woodmen of the World Life Insurance Society.