You are here

Preventive Screening

Preventive Health Guidelines

The Plan follows the below listed care guidelines based on the U.S. Preventive Services Task Force. The Plan’s coverage and payment for some of the below screenings, lab work, and vaccinations, may be different from these guidelines depending on the doctor judgment, state or federal law and other circumstances. Please contact Member Services for questions about benefit coverage information. Persons with symptoms or at high risk for disease may need more care.

Children Younger Than 10 Years Old

Screenings

Height/Weight-Regularly throughout infancy and childhood

Blood Pressure-Periodically* throughout childhood

Vision Screening-Once between ages 3-4

T4 and/or TSH-Optimally between day 2 and 6, but in all cases before discharge from the hospital

PKU level-At birth

Lead Test Screening-Done at 12 and 24 months old; and between 24 and 72 months if not previously screened.

Immunizations

DTaP or DTP-Five immunizations at 2, 4, and 6 months, between 15-18 months and once between ages 4-6

Polio-Four immunizations at 2 and 4 months, between 6-18 months and between ages 4-6

MMR-Two immunizations between 12-15 months and between ages 4-6. If missed, give by ages 11-12

H. influenza type B (Hib)-Three or four immunizations, depending on the vaccine, at 2, 4, and 6 months and between 12-15 months

Hepatitis B-Three immunizations: beginning at Age 2 months or at age 6 months (depending on whether or not the vaccine used contains thimerosal). All three immunizations should be completed by age 18 months. If not immunized by age 11, three immunizations given according to your doctor’s recommendations.

Pneumococcal Conjugate Vaccine-Four immunizations done at 2, 4, 6 and between 12-15 months old

Varicella-One immunization between 12-18 months or older children, if missed, and no history of chicken pox *Frequency should be discussed with your doctor.

Things to Talk to Your Child’s Doctor About:

Diet and Exercise

• Limit fat and cholesterol intake, maintain caloric balance and emphasize grains, fruits and vegetables

• Regular physical activity

Substance Use

• Effects of passive smoking

• Anti-tobacco message

Dental Health

• Baby bottle tooth decay

• Regular dental visits

• Floss, brush and fluoride

Injury Prevention

• Child safety car seats

• Bicycle helmet; avoid bicycling near traffic

• Lap and shoulder seat belts

• Smoke detector, flame retardant sleepwear

• Set hot water heater temperature lower than 120°-130°F

• Window and stair guards, swimming pool fence

• Safe storage of drugs, cleaning supplies, toxins, firearms and matches

• Poison control phone number

• CPR training for parents/caregivers

 

Young Adults 11-24 Years 

Screenings

Height/Weight-Periodically*

Blood Pressure-Periodically*

Papanicolaou (Pap) test-Every one to three years sexually active females or beginning at age 18

Chlamydia screening-Routine* screenings recommended for all sexually active females

Rubella serology or vaccination historyRecommended for all females of childbearing age

Immunizations

Tetanus-diphtheria (Td)-Boosters between ages 11-16 and then every 10 years*

HPV (Human Papillomavirus) – Between ages of 12-26

Hepatitis B-If not previously immunized, one immunization at current (next) visit, one month later and six months later

MMR-Between ages 11-12 if second dose was not received

Varicella-Between ages 11-12 if susceptible to chicken pox

Rubella-Administered after age 12 females who are not pregnant

Other Preventions

Multivitamins with folic acid-Females (Planning/capable of pregnancy)

Diet and Exercise

• Limit fat and cholesterol intake, maintain caloric balance and emphasize grains, fruits and vegetables

• Regular physical activity

• Adequate calcium intake

Substance Abuse

• Avoid underage drinking/illicit drug use

• Avoid tobacco use

Sexual Behavior

• Sexually transmitted disease (STD) prevention/abstinence

• Avoid high-risk behavior

• Unintended pregnancy

Injury Prevention

• Bicycle/motorcycle/ATV helmets-safety

• Lap and shoulder seat belts

• Smoke detectors

• Safe firearm handling

• Set hot water heater temperature lower than 120°-130°

• CPR training for parents/caregivers

Dental Health

• Regular dental visits

• Floss, brush and fluoride

 

Adults 25-64 Years

Screenings

Height/Weight-Periodically*

Blood Pressure-Periodically*

Total Blood Cholesterol-Periodically* males between ages 35-64, females between ages 45-64

Fecal Occult blood test-Annually* beginning at age 50

Sigmoidoscopy-Every 3 to 5 years beginning at age 50

Clinical breast exam-Annually-females between ages 50-69

Mammogram-Every one to two years females between ages 50-69**

Papanicolaou (Pap) test-Every one to three years sexually active females who have not had a hysterectomy

Other Preventions

Discuss hormone replacement therapyPeriodically*, peri- and post-menopausal females

Multivitamins with folic acid-Females (Planning/capable of pregnancy)

Provider Discussion Topics

Diet and Exercise

• Limit fat and cholesterol intake, maintain caloric balance and emphasize grains, fruits and vegetables

• Regular physical activity

• Adequate calcium intake

Substance Abuse

• Avoid alcohol/drug use

• Avoid tobacco use

Sexual Behavior

• Unintended pregnancy

• Sexually transmitted disease (STD) prevention

• Avoid high-risk behavior

Injury Prevention

• Bicycle/motorcycle/ATV helmets-safety

• Lap and shoulder seat belts

• Smoke detectors

• Safe firearm handling

• CPR training for parents/caregivers

Dental Health

• Regular dental visits

• Floss, brush and fluoride

*Frequency should be discussed with your doctor.

 

Adults 65 Years and Older 

Screenings

Height/Weight-Periodically*

Blood Pressure-Periodically*

Papanicolaou (Pap) test-Every one to three years-sexually active females who have not had a hysterectomy; consider discontinuing if previous regular screenings were normal*

Fecal Occult blood test-Annually

Sigmoidoscopy-Every 3 to 5 years

Clinical breast exam-Annually-females between ages 65-69

Mammogram-Every one to two years females between ages 65-69**

Vision Screening-Annually

Hearing Screening-Periodically*

Other Preventions

Discuss hormone replacement therapy- Periodically*, peri- and post-menopausal females

Provider Discussion Topics

Diet and Exercise

• Limit fat and cholesterol intake, maintain caloric balance and emphasize grains, fruits and vegetables

• Regular physical activity

Substance Abuse

• Avoid alcohol/drug use

• Avoid tobacco use

Sexual Behavior

• Sexually transmitted disease (STD) prevention

• Avoid high-risk behavior

Dental Health

• Regular dental visits

• Floss, brush, and fluoride

Injury Prevention

• Lap and shoulder seat belts

• Bicycle and motorcycle helmets-safety

• Safe firearm handling

• Smoke detectors

• Set hot water heater temperature lower than 120°-130°

• CPR training for household members/caregivers

*Frequency should be discussed with your doctor.

Your PCP and a Plan case manager will work with you. We will create a plan to help control your illness. This will improve your quality of life. Plan will contact you if you qualify for these programs.

 

Please call Member Services at 800-887-6888 or call TDD Florida Relay 711. They can give you a copy of our quality improvements programs and information about our quality improvements and disease management programs.