Well visits can be a key part of preventive care. They can reassure members they are as healthy as they feel or prompt them to ask questions about their health.
How the benefit works
State Health Plan primary members are eligible for one well visit each plan year at no member cost. Evidence-supported services, based on the U.S. Preventive Services Task Force (USPSTF) A and B recommendations, are included as part of an adult well visit under the State Health Plan. After talking with your doctor during a visit, the doctor can decide which services you need from the approved USPSTF recommendations and build a personal care plan for you.
Who is eligible?
The benefit is available to all non-Medicare primary adults ages 19 and older who are covered by the Standard Plan or Savings Plan. Adult members can take advantage of this benefit at a network provider specializing in general practice, family practice, pediatrics, internal medicine or gerontology. Members should talk with their physician to determine the best plan for their care.
Eligible female members can also receive an annual adult well woman visit at no cost. Women can take advantage of the well woman benefit at a network provider specializing in obstetrics and gynecology, or they can have a well woman exam in conjunction with or in addition to their annual well visit with a network provider specializing in general practice, family practice, internal medicine or gerontology. A female member may receive both an adult well visit and a well woman visit in the same plan year, but the USPSTF-recommended services will not be covered more than once per plan year. Additionally, female members cannot receive the same service at both an adult well visit and a well woman visit in the same plan year; duplicate services will be denied.
Services not included as part of an adult well visit
Services not included as part of the adult well visit are those without an USPSTF A or B recommendation. Find these recommendations at www.USPreventiveServicesTaskForce.org. Other services, including a complete blood count (CBC), EKG, PSA test and basic metabolic panel, if ordered by your physician to treat a specific condition, may still be covered. These services are subject to copayments, deductibles and coinsurance, as well as normal Plan provisions. Follow-up visits and services as a result of your well visit are also subject to normal Plan provisions.