Prevents future health problems. You receive these services without having any specific symptoms.

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1 Preventive Care To help you live the healthiest life possible, we offer free preventive services for most Network Health members. Please refer to your member materials, which you received when you enrolled with Network Health, for preventive health benefits specific to your benefit plan. What are Preventive Services? Preventive services help you identify diseases or medical problems before you show symptoms. These services include screenings, immunizations, lab tests and other services that help you prevent health problems. When are Preventive Services Free? When you see an in-network provider for one of the services listed in this guide, we ll pay 100 percent for most plans. However, you may be responsible for certain payments (deductible, coinsurance and copayment) if you receive the services for diagnostic reasons. So, what s the difference between preventive and diagnostic? Preventive Services vs. Diagnostic Care Reason for receiving the service Preventive Care Prevents future health problems. You receive these services without having any specific symptoms. Diagnostic Care You have a specific health issue with known symptoms. What you pay You pay nothing. You pay for the service as a medical claim, meaning your deductible, copayment and coinsurance may apply. c-qim-prvcareflr-1013 Continued on next page

2 Examples of Diagnostic and Preventive Care Any follow-ups tests, tests to monitor a chronic disease and any tests not listed in this guide are considered diagnostic. Here s a guide to help you understand when certain common services are considered preventive or diagnostic. Colon cancer screening Diabetes screening Osteoporosis screening Preventive based on family history. If a polyp is found and removed during the preventive colonoscopy, then the screening and removal are considered preventive. A general blood glucose test to detect your blood sugar levels, even though you have no symptoms. You receive a bone density test based on your age or family history. Diagnostic You receive the screening because of a health problem, like bleeding, or if a polyp is removed and sent for lab testing, testing is diagnostic. You have a diabetes diagnosis and your doctor checks your levels. The test is given due to a health problem you are having. Metabolic panels Never preventive Always diagnostic because studies show that metabolic panels aren t effective enough for detecting of preventing illnesses. Prostate exam Never preventive Always diagnostic because national guidelines indicate that this test gives many false results. Urinalysis Never preventive Always diagnostic because national guidelines state there s no need for the test unless you show symptoms. How do we determine which services are considered preventive? Our recommendations for preventive care are based on medical research from nationwide organizations like the U.S. Preventive Services Task Force. These guidelines can change from year to year depending on new research. If you have any questions about Network Health s preventive services, please call our customer service department at or

3 Network Health s Preventive Services CHILDREN S HEALTH Newborns Through Age 18 NAME Track the services your child has received by completing the column. If you need more copies for additional children, visit networkhealth.com/members. Select the Preventive Care tab on the right side of the page and click on the Learn More button. Physical Exams (Well-Child Visits) Age Newborn One visit three to five days after discharge. 0-2 years One visit at two, four, six, nine, 12, 15, 18 and 24 months. 3-6 years One visit at 30 months and one visit every 12 months for ages three to six years One visit every one to two years years One visit every year. Immunizations (doses, ages and recommendations vary) Vaccine Chicken Pox (varicella) Diphtheria, Tetanus, Whooping Cough (pertussis) Flu Haemophilus Influenza Type B One dose between months old. Children between 12 months and 12 years can get one dose if they have no history of chicken pox. A second dose is given between ages four to six. Two doses for children between 7-18 years if no history of chicken pox and no previous vaccination. One dose of DTaP at two, four, six and 18 months old. One dose of Tdap between 11 and 12 years with a Td booster every 10 years after. Children over seven years old and not previously immunized can get a single dose of TdaP. Two doses for healthy children between six months and eight years old the first time they get it. There should be four weeks between the first and second dose. After age two, children who previously received the shot can get one dose annually. One dose at two, four and six months and once between 12 and 18 months old. 3

4 Vaccine Hepatitis A Hepatitis B HPV (human papillomavirus) Polio (inactivated poliovirus) Measles, Mumps, Rubella (MMR) Meningitis (meningococcal) Pneumonia (pneumococcal) Rotavirus Two doses at least six months apart between months old. For children not previously immunized, two doses can be given at least six months apart at the doctor s discretion. One dose to all newborns before leaving the hospital, a second dose between one and two months and a third dose between six and 18 months. May begin between two to 18 years old if not immunized as a baby. Three doses over a 24-week period starting at age 11. Your doctor may give the vaccine as early as age nine if the child is at high risk. One dose at two and four months old and between 16 and 18 months (three doses total). Then, one dose between ages four and six. One dose between 12 and 15 months and a second between four and six years. Can be given to older children if no history of vaccination or disease. One dose between 11 and 12 years. Doctors may give vaccine as early as age two if the child is at high risk. One dose at two, four and six months and again at 12 to 15 months. Children over age two can get a single dose if not previously immunized. Children with an underlying medical condition can receive an additional dose. Children at high risk can be vaccinated after age seven. One dose at two, four and six months old. Drugs Prescription required Prescription Iron Supplements Oral Fluoride Supplements Children ages six to 12 months at risk for iron deficiency (check with customer service for coverage information). Children six months and older without fluoride in their water source (check with customer service for coverage information). Doctor Visits and Tests Assessments, s and Alcohol and Drug Use Assessment Autism Ages 11 to 18 during each visit. to those at risk. At 18 and 24 months. Blood Pressure Every year starting at age three. 4

5 Assessments, s and Congenital Hypothyroidism Cervical Dysplasia Depression and Behavioral Assessments Developmental Dyslipidemia (cholesterol screening) Gonorrhea Preventive Medication Once at birth. For sexually active females. At your doctor s discretion for children of all ages. At nine, 18 and 30 months old, with checkups throughout development. Routine lab testing is not recommended but may be done for children at high risk. Once at birth. Hearing Loss Annually newborn through age 18. Height, Weight and Body Mass Index Hematocrit or Hemoglobin (anemia) HIV Lead Medical History Newborn s Obesity and Physical Activity and Nutrition Oral Health Risk Assessment Sexually Transmitted Infections (STI) Prevention and Tobacco-Use and Tuberculosis (TB) Testing Vision Height and weight at each visit up to age two. After age two, body mass index. Once at 12 months, or if at risk. For children ages and younger adolescents at high risk. At 12 and 24 months for children at high risk. Risk assessment for lead exposure between six and 12 months old, 24 months and between two and six years. All children at each well-child visit. Once at birth. At your doctor s discretion starting at age six. At 12, 18, 24 and 30 months of age and three and six years old. At your doctor s discretion for all sexually active adolescents. During each visit. Includes cessation interventions for tobacco users and expanded counseling for pregnant tobacco users. At your doctor s discretion for high-risk children. For all children as part of a well-child checkup. 5

6 ADULT HEALTH Keep track of the services you ve received by completing the column. Physical Exams NAME Age Once every two to three years, annually if desired Once every one to three years. 65 and older One visit every year. Immunizations (doses, ages and recommendations vary) Vaccine Chicken Pox (varicella) Flu Hepatitis A Hepatitis B HPV (human papillomavirus) Measles, Mumps, Rubella (MMR) Pneumonia (pneumococcal) Shingles (herpes zoster) Tetanus, Diphtheria and Whooping Cough (pertussis) (Tdap/Td) Two doses four weeks apart for those with no history of vaccination or disease. One dose yearly. Two doses for those at high risk. Three doses for those at high risk. Three doses over a 24-week period up to age 26. One to two doses if no history of vaccination or disease. Can be given after age 40 if at high risk. One dose for 65 and older. Those at high risk or with a history of asthma or smoking should have one dose between ages 19 and 64 with a booster every five years. One dose for those 50 and older. One dose if no history of pertussis vaccine regardless of interval since last tetanus vaccine, followed by Td every 10 years. This vaccine is recommended especially if the patient has contact with children under age one. Drugs Prescription required Prescription Low-Dose Aspirin Therapy to Prevent Heart Disease For men and women ages and other with risk factors. Consult your doctor before starting. 6

7 Doctor Visits and Tests Assessments, s and Abdominal Aortic Aneurysm Advance Care Planning Alcohol Misuse and Behavioral Anticipatory Guidance for Family and Intimate Partner Violence, Abuse of Elderly and Vulnerable Adults, Breast Self-Exam, Menopause, Safety, Falls and Injury Prevention Blood Pressure Cholesterol Test (lipoprotein profile) Colon Cancer Depression Diabetes Diet Height, weight and body mass index (BMI) Hepatitis C HIV Medical History Obesity and Sexually Transmitted Infections (STI) and Tobacco-Use and Tuberculosis (TB) Testing Once for year-old men with a history of smoking. During a physical exam. During a physical exam. At doctor s discretion. During a physical exam. A fasting test (total cholesterol, LDL, HDL and triglyceride) once every five years, or at doctor s discretion. Beginning at age 50, one of the following screenings: Every 10 years A colonoscopy (lighted tube placed in rectum that allows the doctor to see the large bowel) Every five years A flexible sigmoidoscopy (lighted tube placed in rectum that allows the doctor to see the lower bowel) Fecal occult blood test (stool tested for hidden blood) During physical exam. for adults with high blood pressure. At your doctor s discretion if you re at high risk for heart and diet-related chronic diseases. During physical exam. for patients at high risk. One-time screening for adults born between for adults ages and older adults who are at high risk. During physical exam. and counseling/behavioral interventions at your doctor s discretion. At your doctor s discretion for all sexually active adults. At each visit. At your doctor s discretion if you re at high risk of tuberculosis. 7

8 WOMEN S HEALTH NAME Keep track of the services you ve received by completing the column. Remember, the Adult Health section on page six contains more care that s recommended for all adults. Doctor Visits and Tests Assessments, s and Chlamydia Contraceptive and Contraception Methods and for Sexually Transmitted Infections for Breast Cancer BRCA 1 and BRCA 2 Gene Mutation Domestic Violence and Human Immune- Deficiency Virus (HIV) and HPV (human papillomavirus testing) Mammogram (breast cancer screening) Osteoporosis Pap Test (cervical dysplasia/cancer screening) Well-Woman Visits (physical exams) All sexually active women age 24 and under and at-risk women age 25 and older. Access to FDA-approved female contraceptive methods, sterilization procedures and patient education and counseling. Annually for sexually active women. for women at high risk for breast cancer who may benefit from breast cancer prevention. Women at high risk. Annually Annually for sexually active women. Every three years for women starting at age 30, regardless of Pap test results. Every one to two years starting at age 40. Women 65 and older and younger women whose fracture risk is equal to or greater than that of a 65 year-old white female who has no additional risk factors. Start screening at beginning of sexual activity or at age 21, whichever comes first. For ages 30 and older, screening every three years. Routine screening for females 65 years and older is not recommended unless identified as high risk. Annually or at your doctor s discretion. 8

9 PREGNANT WOMEN NAME If you re expecting, trying to get pregnant or if you ve recently given birth, we recommend the following preventive care. Remember, you can keep track of the services you ve received by completing the column. Doctor Visits and Tests Assessments, s and Bacteriuria with Urine Culture Breastfeeding Support, Supplies and Gestational Diabetes Hematocrit or Hemoglobin Hepatitis B Between 12 and 16 weeks gestation or during first prenatal visit if later. Lactation support and counseling to pregnant and postpartum women, including costs of breastfeeding equipment. Women 24 to 28 weeks pregnant and those identified as high risk for gestational diabetes. During the first prenatal visit. During the first prenatal visit. HIV Iron-Deficient Anemia Rh Incompatibility On first visit and those who present in labor who are untested and whose HIV status is unknown. On a routine basis. On first visit and follow-up testing for women at high risk. The Preventive Health Care Guidelines were developed and approved by Network Health. References American Academy of Family Physicians, American Academy of Pediatrics, American Cancer Society, American College of Obstetricians and Gynecologists, American College of Physicians, American Medical Association, National Cancer Institute, U.S. Preventive Services Task Force, U.S. Public Health Service. Go to ahrq.gov/clinic/prevenix.htm for a complete list of evidence-based preventive services and risk factors from USPSTF. HMO plans underwritten by Network Health Plan. POS plans underwritten by Network Health Insurance Corporation, or Network Health Insurance Corporation and Network Health Plan. Self-funded HMO and POS plans administered by Network Health Plan. 9

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