One of the most important things you can do for your health is to schedule regular checkups with your Primary Care Provider (PCP).
Frequently Asked Questions
What are the health maintenance guidelines?
Does my health insurance cover these preventive care exams?
The health care reform Affordable Care Act (ACA) requires that plans begin providing benefits for preventive services with no member cost share, such as copayments, deductibles, and coinsurance, when services are performed by in-network providers. However, some plans are not required to comply with this mandate.
If your contract is affected by this change, Wellmark will provide first-dollar coverage for covered preventive services performed by in-network providers. Claims for preventive services from out-of-network providers will process using the benefits specified in your benefits policy or coverage manual, and will continue to apply member cost-sharing amounts.
The change will become effective in stages over the next several months, depending on your health plan. For more details about your preventive benefits, contact Customer Service at the number on your identification card.
What is a health maintenance exam (HME)?
How is the frequency of health maintenance exams determined?
Wellmark's guidelines are reviewed annually. We provide benefits for health maintenance exams at timeframes that are considered most appropriate given your age and gender.
What is the difference between a health maintenance exam and a well-female exam?
These exams are recommended every five years from ages 18-39, every 2-3 years from ages 40-49, and every 1-2 years for ages 50 and over.
Well-female exams are far less extensive, limited essentially to pelvic and Pap tests, as well as your clinical breast exam. Well-female exams can be performed by your primary care provider or selected Plan OB/GYN provider.
How often should I have a well-female exam?
What if my child has already had his or her health maintenance exam this year, but is now required to have a sports physical for school?
If there is a range recommended for an exam, how often should I schedule the exam?
What if my provider recommends that I have these exams more frequently?
If the reason for a more frequent exam schedule is due to an underlying chronic disease, benefits would apply. However, if your physician just wants you to have health maintenance exams at a more frequent rate than once per benefit period, the additional exams are not a covered benefit.