Schedule

Every 1-3 years. The recommended schedule applies only to the periodic visit itself. The frequency of the individual preventive services is left to clinical discretion (except as indicated). The preventive services are listed below.

DISCLAIMER: Coverage of preventive services varies under PPO and indemnity plans. Members covered under these policies need to refer to their Certificate of Coverage or contact a customer service representative for information regarding covered services.

Screening:

History:

• Dietary intake
• Physical activity
• Tobacco/alcohol/drug use
• Sexual practices
• R.O.S.

Physical Exam:

• Height and weight
• blood pressure

  High-Risk Groups:

• Complete oral cavity exam [HR1]
• Palpation for thyroid nodules [HR2]
• Clinical breast exam[HR3]
• Clinical testicular exam [HR4]
• Complete skin exam[HR5]

Laboratory/Diagnostic Procedures:

• Nonfasting total blood cholesterol-every 5 years for Females age 45 - 70; Males age 35 - 70
• Papanicolaou smear every 3 years after 2 normal results

  High-Risk Groups

• Mammogram [HR3]
• Plasma glucose [HR6]
• Rubella antibodies [HR7]
• VDRL/RPR [HR8]
• Urinalysis for microalbuminuria [HR9]
• Chlamydia testing[HR10]
• Gonorrhea culture [HR11]
• Counseling and testing for HIV [HR12]
• Hearing [HR13]
• Tuberculin skin test (PPD) [HR14]
• Electrocardiogram [HR15]
• Colonoscopy [HR16]

Immunizations and/or Chemoprophylaxis

• Tetanus-diphtheria (Td) booster - Every 10 years

  High-Risk Groups:

• Hepatitis B vaccine [HR24] (if not given previously)
• Pneumococcal vaccine [HR25]
• Influenza vaccine - Annually [HR26]
• Measles-mumps-rubella vaccine [HR27]

Patient and/or Parent Counseling

Diet and Exercise:

• Fat (especially saturated fat), cholesterol, complex carbohydrates, fiber, sodium, iron and calcium (for women)
• Caloric balance
• Selection of exercise program

Substance Use:

• Tobacco: cessation/primary prevention

  Alcohol and Other Drugs:

• Limiting alcohol consumption.
• Driving/other dangerous activities while under the influence.
• Treatment for abuse.

  High-Risk Groups:

• Sharing/using unsterilized needles and syringes [HR18]

Sexual Practices:

• Sexually transmitted diseases: partner selection, condoms, anal intercourse
• Unintended pregnancy and contraceptive options

Injury Prevention:

• Safety belts
• Safety helmets
• Violent behavior - Especially for young males
• Firearms safety - Especially for young males
• Smoke detector
• Smoking near bedding or upholstery

  High-Risk Groups:

• Back-conditioning exercises [HR19]
• Prevention of childhood injuries [HR20]
• Falls in the elderly [HR21]

Dental Health:

• Regular tooth brushing, flossing, dental visits

Other Primary Preventive Measures:

High-Risk Groups:

• Discussion of hemoglobin testing [HR22]
• Skin protection from ultraviolet light [HR23]

Remain Alert for:

• Depressive symptoms
• Suicide risk factors [HR17]
• Abnormal bereavement
• Malignant skin lesions
• Tooth decay, gingivitis
• Signs of physical abuse

Leading Causes of Death

• Motor vehicle injuries
• Homicide
• Suicide
• HIV infection
• Heart disease

Definitions of High Risk Patients

These definitions apply to the category of Ages 19-39 only.

TERM DEFINITION

• HR1: Persons with exposure to tobacco or excessive amounts of alcohol, or those with suspicious symptoms or lesions detected through self-examination.
  
  
• HR2: Persons with a history of upper-body irradiation.

• HR3: Women aged 35 and older with a family history of premenopausal diagnosed breast cancer in a first-degree relative.
  
  
• HR4: Men with a history of cryptorchidism, orchiopexy, or testicular atrophy.
  
  
• HR5: Persons with family of personal history of skin cancer, increased occupational or recreational exposure to sunlight, or clinical evidence of precursor lesions (e.g., dysplastic nevi, certain congenital nevi).
  
  
• HR6: The markedly obese, persons with a family history of diabetes, or women with a history of gestational diabetes.
  
  
• HR7: Women lacking evidence of immunity.
  
  
• HR8: Prostitutes, persons who engage in sex with multiple partners in areas in which syphilis is prevalent, or contacts of persons with active syphilis.
  
  
• HR9: Persons with diabetes.
  
  
• HR10: Persons who attend clinics for sexually transmitted diseases; attend other high-risk health care facilities (e.g., adolescent and family planning clinics); or have other risk factors for Chlamydia infection (e.g., multiple sexual partners or a sexual partner with multiple sexual contacts, age less than 20.
  
  
• HR11: Prostitutes, persons with multiple sexual partners or a sexual partner with multiple contacts, sexual contacts of persons with culture-proven gonorrhea, or persons with a history of repeated episodes of gonorrhea.
  
  
• HR12: Persons seeking treatment for sexually transmitted diseases; homosexual and bisexual men; past or present intravenous (IV) drug users; persons with a history of prostitution or multiple sexual partners; women whose past or present sexual partners were HIV-infected, bisexual, or IV drug users; persons with long-term residence of birth in an area with high prevalence of HIV infection; or persons with a history of transfusion between 1978 and 1985.
  
  
• HR13: Persons exposed regularly to excessive noise.
  
  
• HR14: Household members of persons with tuberculosis or others at risk for close contact with the disease (e.g., staff or tuberculosis clinics, shelters for the homeless, nursing homes, substance abuse treatment facilities, dialysis units, correctional institutions); recent immigrants or refugees from countries in which tuberculosis is common; migrant workers, residents of nursing homes, correctional institutions, or homeless shelters; or persons with certain underlying medical disorders (e.g., HIV infection).
  
  
• HR15: Persons who would endanger public safety if they were to experience sudden cardiac events (e.g., commercial airline pilots).
  
  
• HR16: Persons with a family history of familial polyposis coli or cancer family syndrome.
  
  
• HR17: Recent divorce, separation, unemployment, depression, alcohol or other drug abuse, serious medical illnesses, living alone, or recent bereavement.
  
  
• HR18: Intravenous drug users.
  
  
• HR19: Persons at increased risk for low back injury because of past history, body configuration, or type of activities.
  
  
• HR20: Persons with children in the home or automobile.
  
  
• HR21: Persons with older adults in the home.
  
  
• HR22: Young adults of Caribbean, Latin American, Asian, Mediterranean, or African descent.
  
  
• HR23: Persons with a family history of skin cancer, large number of moles, light skin/hair/eye color.
  
  
• HR24: Homosexually active men, intravenous drug users, recipients of some blood products, or persons in health-related jobs with frequent exposure to blood or blood products.
  
  
• HR25: Persons with medical conditions that increase the risk of pneumococcal infection (e.g., chronic cardiac or pulmonary disease, sickle cell disease, nephrotic syndrome, Hodgkin's disease, asplenia, diabetes mellitus, alcoholism, cirrhosis, multiple myeloma, renal disease, or conditions associated with immunosuppression).
  
  
• HR26: Residents of chronic care facilities or persons suffering from chronic cardiopulmonary disorders, metabolic diseases (including diabetes mellitus), hemoglobinopathies, immunosuppression, or renal dysfunction.
  
  
• HR27: Persons born after 1956 who lack evidence of immunity to measles (receipt of live vaccine on or after first birthday, laboratory evidence of immunity, or a history of physician-diagnosed measles).