Tag Archives: physicals

Children's Preventive Care

Your Children’s Preventive Care and Physicals

Getting your kids to their physicals and checkups, where they can get covered children’s preventive care and screenings, helps them be their healthiest. It’s important not only that you know what’s recommended for their ages and what they need to stay up to date, but also that you get them to the doctor for this on the right schedule.

What Happens at Their Physical

Your child needs to have regular wellness visits with their doctor to focus on their development, health, and wellness. At the appointment, some of the basics your doctor will cover are:

  • Checking that your child is developing at a healthy rate and tracking their health information and history
  • Getting a physical exam
  • Staying up to date with their preventive care
  • Getting education and counseling
  • If needed, setting health goals

Visit Schedule

Your baby needs to go to well-baby visits at:

  • 1 month old
  • 2 months old
  • 4 months old
  • 6 months old
  • 9 months old

Children need to visit their doctor at:

Adolescents and teens should visit the doctor at least once a year:

Choose a visit from the lists above to learn more about what will happen at that visit.

Children’s Preventive Care

Certain children’s preventive care and screenings are always covered, depending on timing and what your doctor recommends.

Newborns

  • Gonorrhea preventive medication
  • Hearing screening
  • Hemoglobinopathies or sickle cell screening
  • Hypothyroidism screening
  • Phenylketonuria (PKU) screening

Babies and Small Children

0 to 11 months
  • Behavioral assessment
  • Blood pressure screening
  • Height, weight, and body mass index (BMI) measurements
  • Medical history
  • Tuberculin testing
  • Oral health risk assessment
  • Iron supplements for children ages 6 to 12 months at risk for anemia

Children

1 to 4 years
  • Behavioral assessment
  • Blood pressure screening
  • BMI measurements
  • Medical history
  • Tuberculin testing
  • Oral health risk assessment
  • Iron supplements for children ages 6 to 12 months at risk for anemia
  • Autism screening for children at 18 and 24 months
  • Developmental screening for children under age 3
5 to 10
  • Behavioral assessment
  • Blood pressure screening
  • BMI measurements
  • Medical history
  • Tuberculin testing
  • Oral health risk assessment

Adolescents/Teenagers

11 to 14
  • Behavioral assessment
  • Blood pressure screening
  • BMI measurements
  • Medical history
  • Tuberculin testing
  • Hepatitis B screening for adolescents at high risk
  • Alcohol and drug use assessments
  • Cervical dysplasia screening for sexually active females
  • Depression screening
  • Sexually transmitted infection (STI) prevention
  • counseling and screening for adolescents at higher risk
15 to 17
  • Behavioral assessment
  • Blood pressure screening
  • BMI measurements
  • Medical history
  • Tuberculin testing
  • Hepatitis B screening for adolescents at high risk
  • Alcohol and drug use assessments
  • Cervical dysplasia screening for sexually active females
  • Depression screening
  • Sexually transmitted infection (STI) prevention
  • counseling and screening for adolescents at higher risk

General

  • Obesity screening and counseling
  • Hematocrit or hemoglobin screening
  • Lead screening for children at risk of exposure
Dental and Vision

Plans that meet the Affordable Care Act’s essential health benefits also include some vision and dental coverage:

  • Dental exam every 6 months
  • Cleanings, fluoride treatments, and X-rays
  • Fluoride chemoprevention supplements for children without fluoride in their water source
  • Yearly vision screening for all children
  • Most people can get help with their child’s glasses or contacts on their plan too

You can also buy extra dental coverage to add to your plan for a low monthly cost.

Immunizations

Vaccines, or shots, are an important part of your children’s preventive care. These should be delivered on a specific schedule to make sure your kids are protected at every age. Shots that are listed more than once at different ages include multiple doses to finish the vaccine.

Newborn
  • Hepatitis B
1 to 2 month
  • Hepatitis B
2, 4, and 6 months
  • Diphtheria, Tetanus, Pertussis (DTaP)
  • Haemophilus influenza type b (Hib)
  • Polio
  • Pneumococcal conjugate
  • Rotavirus
6 to 18 months
  • Hepatits B
  • Polio
  • 2 flu shots (6 months or older)
12 months and older
  • 12 to 15
    • Hib
    • Pneumococcal conjugate
    • Measles, Mumps, Rubella (MMR)
    • Varicella (Chickenpox)
  • 12 to 18
    • DTaP
  • 12 to 23
    • Hepatitis A
18 months and older
  • Hepatits A
  • Flu shot once a year
4 to 6 years
  • DTaP
  • Polio
  • MMR
  • Varicella
  • Flu shot once a year
11 to 12
  • Tdap (booster to DTaP)
  • Meningococcal A, C, W, and Y (MenACWY)
  • Human Papillomavirus (HPV) – 2 doses
  • Flu shot once a year
16 years
  • MenACWY
  • Flu shot once a year
18 years
  • Meningococcal B (MenB) – Talk to your child’s doctor to find out if they need this vaccine.
  • Flu shot once a year

Visit the Centers for Disease Control and Prevention (CDC) and enter your child’s birth date to get a customized shot schedule.

Know What’s Covered

Learn more about what immunizations are covered for your children. And log in to Your Health Alliance or search by your or your child’s member number to see what children’s preventive care your family’s plan covers.

You can use our general preventive care guidelines and prescription drugs to get an idea of what our plans cover.

If you’re not sure what’s covered and what you’ll need a preauthorization for, you can check your coverage and preauthorization lists at Your Health Alliance.

Now that you’re ready for your children’s physicals, log in to Your Health Alliance if you need to set a Primary Care Provider (PCP) for your child or start searching for doctors in our network.

Active with Medicare Advantage Extras

Everyone Loves Extras

We’ve been mentioning Health Alliance Medicare Advantage’s great extras for weeks, today we’re telling you all about them!

Healthways SilverSneakers® Fitness Program

SilverSneakers helps you get fit the way you want, at your convenience. Reach your fitness goals with access to more than 11,000 fitness locations, where you can:

  • Use all basic amenities, plus take SilverSneakers classes*
  • Get guidance and assistance from a Program AdvisorSM
  • Enjoy fun social activities

You can also choose 1 of 4 fitness kits. They help you maintain good health, and gain balance and muscle strength, without leaving your home.

SilverSneakers also gives members a secure online community with access to:

  • Easy-to-use nutrition, fitness, and health tracking tools
  • Fun exercise videos and demonstrations
  • Expert advice on exercise, nutrition, and life skills

Assist America

No matter where you are in the world, Assist America connects you to the help you need. They link you to quality emergency medical care while traveling. These are just a few of the great features our members get:

  • Medical referrals
  • Emergency medical evacuation
  • Medical repatriation
  • Prescription assistance
  • Compassionate visit
  • Return of mortal remains
  • Lost luggage assistance
  • Interpreter and legal referrals

$0 Tier 1 Drugs at Walmart and Sam’s Club

Sound too good to be true? It’s not. Members with prescription drug coverage get Tier 1 prescription drugs at Walmart and Sam’s Club for $0. Tier 1 drugs feature the most-used drugs on our formulary.

You pay low copayments when you go to other in-network pharmacies.

Be Well

We take care of you, when you’re healthy and when you’re sick.

When you’re healthy, we help connect you to:

  • Yearly physicals
  • Routine screenings, like mammograms or colonoscopies
  • Yearly dental cleanings
  • Timely immunizations
  • Member magazines that share health info and plan details
  • Quit For Life stop-smoking program

When you’re sick, we help connect you to:

  • Case Management to help explain your diagnosis and test results, assist with home care, and discuss treatment options
  • Disease Management Programs
  • Anytime Nurse Line

Call 1-888-382-9771 (TTY 711) from 8 a.m. to 8 p.m. weekdays. Or visit HealthAllianceMedicare.org for more info.

Health Alliance Medicare is an HMO, PPO, and PDP plan with a Medicare contract. Enrollment depends on contract renewal. You must continue to pay your Part B premium. Low-cost prescriptions are available at other in-network pharmacies. The benefit information here is just a brief summary, not a complete description of benefits. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium, and/or copayments/coinsurance may change on January 1 of each year.

Essential Health Benefits: Get More for Your Money

Upgrading to the Meal

That glorious moment when the server at a restaurant clarifies that your meal comes with a drink … not for an extra cost, but with. Wow, what a moment. As of January 1, 2014, your health insurance plan comes with Essential Health Benefits.

If you’ve been a Health Alliance member before, we’ve covered many of these benefits for years, so you won’t see or feel much change. But if you’re new to us, welcome and enjoy!

Essential Health Benefits stretch across 10 categories. By law, no matter your age, gender, or medical history, you’re covered in these 10 areas.

Essential Health Benefits

Details

Ambulatory Patient Services Care you get at a doctor’s office, clinic, or outpatient surgery center, including home health services and hospice care.
Emergency Services Care provided in an emergency situation where you believe your health is in serious danger, like chest pain, a broken bone, or unconsciousness.
Hospitalization Care from doctors, nurses, and hospital staff, room and board, surgeries, and transplants you receive during your hospital stay, or care in a skilled nursing facility.
Laboratory Services Testing to help a doctor diagnose an injury, illness, or condition, or monitor how well a treatment is working.
Maternity and Newborn Care Prenatal care through newborn care.
Mental Health Services and Addiction Treatment Inpatient and outpatient care to treat a mental health condition or substance abuse.
Rehab Services and Devices Services and devices to help you regain mental and physical skills lost because of injury, disability, or a chronic condition.
Pediatric Services Wellness visits and recommended vaccines and immunizations for infants and children, as well as dental and vision care for children under 19 years old.
Prescription Drugs Antibiotics and medicines to treat an ongoing condition, like high cholesterol.
Preventive and Wellness Services and Chronic Disease Treatment Physicals, immunizations, preventive screenings, and care for chronic conditions, like asthma and diabetes.

*Some services do have limits.