Health Management Programs
Preventive Care Guidelines
One of the most important things you can do for your health and your
family's health is to schedule regular checkups with your primary care
provider (PCP).
You'll find most everything you need to know about scheduling important
checkups for you and your family - for immunizations, physical exams,
mammograms, cancer screenings, and more. Use this information to help
keep you and your family on the road to good health. Bring the schedules
to your next checkup or office visit, and discuss them with your physician.
Questions and Answers
Confused about when to schedule a physical? Just what is a "well-female" exam?
And, what preventive benefits are available through your health plan?
You'll find the answers here. Read on for answers to your most commonly
asked questions about preventive care.
What are the preventive care guidelines?
The guidelines were developed to help keep you and your family on track
with preventive care screenings and exams needed for your particular
age and gender.
For infants and young children, the focus of the guidelines is on physical
and mental development, immunizations, nutrition, and safety. For children
and young adults, the focus is on maintaining or developing healthy lifestyle
habits and eliminating high-risk behaviors. With adults, the focus continues
to be on eliminating high-risk behaviors, however, screening for chronic
and/or life-threatening disease becomes more important. Does my health insurance cover these benefits?
Generally, all health plan members have benefits for the exams
and screenings when they are provided as recommended.
An office visit copayment may apply. If your employer group is self-insured,
these benefits may be altered. If
you have questions, contact Customer Service at the number on your
ID card.
What is a health maintenance exam (HME)?
A health maintenance exam is what was commonly known as a "routine" or "annual" physical.
You might be familiar with having a physical annually. Your health benefits,
however, do not necessarily cover "annual" physicals. Instead, your
benefits cover periodic health maintenance exams.
How is the frequency of health maintenance exams determined?
Our guidelines are based on published recommendations from, among others, the
American Academy of Pediatrics, The American Academy of Family Practice,
the American College of Obstetrics and Gynecology, and the Center for Disease
Control. 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?
A health maintenance exam is a complete physical, including health history,
a review of all health and lifestyle risk factors, an exam of all systems including
cardiovascular, respiratory, neurological, musculoskeletal, reproductive and
behavioral, laboratory studies appropriate for age, risk and sex, and discussion
of recommended lifestyle changes. 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?
Well-female exams are recommended for women 18 and over.
Sexually active women should have well female exams every 1-3 years. Discuss
with your physician the interval that is appropriate for you.
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?
Since your child already had a health maintenance exam, it is usually not necessary
to also have a separate sports physical. In this case, have your provider complete
your child's schools physical form, and use the date of the previous health
maintenance exam. This should be acceptable documentation for the school's
purposes.
If an exam is recommended for an age range, such as 1-2 years, how often
should I schedule the exam?
Where there is a range, such as 1-2 years, talk to your physician about how
often you need to have the exam.
What if my provider recommends that I have these exams more frequently?
In most cases, your benefits provide additional coverage for an exam
to be performed once per benefit period. If the reason for a more frequent
exam schedule is due to an underlying chronic disease, benefits would
apply and your physician should code the exam with the appropriate
diagnostic code. 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.
Official Preventive Guidelines
The following guidelines were created by Wellmark Health Plan
of Iowa and its participating physicians. Your physician's practices
may
vary from the schedule shown here. If you have chronic health problems
or special needs, you may need to be seen more frequently.
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