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Take Care of Yourself

The first step in treating any illness is prevention. That’s why Wellmark covers your preventive care and health screenings at little to no cost to you. In fact, with an in-network provider, the exams are 100 percent paid for. By taking advantage of this benefit, you can improve your health and reduce the risk of high medical expenses down the road.

Preventive care includes physicals, immunizations and health screenings like mammograms, prostate exams and blood tests. In addition to these regular check-ups, preventive care includes treatment for chronic conditions like asthma, diabetes and high cholesterol.

In most cases, you'll see your primary care physician (also known as a personal doctor) for preventive care services. Having that relationship, that trust, with a “family” doctor goes a long way toward identifying potential health problems. Over the long term, a doctor intimately familiar with your medical history can see small changes in a condition that a new doctor might not see.

While your out-of-pocket costs will vary between plans, all our plans make preventive care affordable, so you can stay healthier.

Questions? We've Got Answers.

Guidelines for preventive screenings and exams vary, depending on your age and gender. For infants and young children, we focus 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. For adults, the focus continues to be about eliminating high-risk behaviors; however, screening for chronic and/or life-threatening disease becomes more important.

Most likely, yes. The Affordable Care Act (ACA) requires plans to provide benefits for preventive services with no member cost share (such as copayments) when in-network providers perform the services. Since January 2014, all new Wellmark plans have been ACA-compliant. However, some group plans and pre-ACA “grandfathered” plans aren’t required to comply with the mandate.

If you are a Wellmark member, the best way to make sure your plan covers preventive care is to check your coverage manual.

Yes. An HME, more commonly known as a routine physical, is an exam where your doctor evaluates your body, organs and overall health. Individual health factors, like age and gender, help determine how often you need an exam. Depending on your plan’s benefits, you may be covered for an annual exam or a periodic exam.

We provide benefits for your health maintenance exams at intervals appropriate for your age and gender. It may be once a year for a 35-year-old’s mammogram or every two years for a college student’s physical.

Your doctor may recommend health maintenance exams more or less frequently, but that usually won’t affect your benefits.

A health maintenance exam is a complete physical. It includes:

  • Health history
  • Review of health and lifestyle risk factors
  • Exam of cardiovascular, respiratory, neurological, musculoskeletal, behavioral and reproductive systems
  • Laboratory studies appropriate for age, risk and gender
  • Discussion of recommended lifestyle changes

The recommendation is every five years for ages 18–39, every two to three years for ages 40–49, and every one to two years for ages 50 and over.

Well-female exams are far less extensive, limited essentially to pelvic and Pap tests and clinical breast exams. Your primary care provider or select plan OB/GYN providers can perform well-female exams.

We recommend well-female exams for all women 18 and over. Sexually active women should have well-female exams every one to three years. Talk to your doctor about the interval that’s right for you.

Since your child already had a health maintenance exam, it‘s not usually necessary to have a separate sports physical. Have your provider complete the school's physical form and use the date of the last physical examination. This should be acceptable documentation for school purposes.

When there is a range, such as one to two years, always talk to your doctor about how often you need to have the exam.

In most cases, your benefits cover an exam once per benefit period. If the reason for a more frequent exam schedule is an underlying chronic disease, benefits would apply. However, if your doctor just wants you to have health maintenance exams at a more frequent rate, the additional exams are not a covered benefit. If that is the case, talk with your doctor about your options.

NOTE: Recommendations from the American Academy of Pediatrics, the American Academy of Family Practice, the American College of Obstetrics and Gynecology, and the Center for Disease Control, among others, help set our guidelines. Always be sure to review the guidelines annually.