The preventive care benefits covered under the plan include:

A. Services with an A or B rating recommended by the United States Preventive Services Task Force (USPSTF).

B. Immunizations for routine use in children, adolescents and adults who have a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.

C. With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA).

D. With respect to women, evidence-informed preventive care and screening provided for in comprehensive guidelines supported by HRSA (not otherwise addressed by the recommendations of USPSTF).

E. All Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.

F. Routine physical exam and associated diagnostic tests and immunization.

G. Prostate specific antigen tests.

H. Mammograms are limited to one baseline mammogram beginning at age 35 and then annually for ages 40–74.

I. Shingles vaccination beginning at age 50.

For a complete listing on the services covered as “Preventive Care” by the plan, please refer to the Summary Plan Description (SPD).