Qualifying Event Age Based Screenings
Age Based Screenings are Qualifying Events for the Ultimate and Best Plan Levels
The guidelines for the age-based screenings were determined According to the American Academy of Family Physicians (AAFP) and the American Cancer Society (ACS) recommendations.
Complete all required Age Based Screenings with appropriate Providers and document on the Wellness Exam Form. Refer to the Wellness Exam Form for details.
Aged Based Screenings
- Female Pap Smear/Pelvic Exams can be done by an OB/GYN or Primary Care Physician
- Screenings are AAFP & ACS recommendations. Complete according to the age guidelines provided or as physician ordered.
FEMALE
- Clinical Breast Exam & Pelvic Exam Annually
- Pap Smear* Every 3 years starting at age 21 or as recommended by physician
- Mammogram Every 2 years starting at age 40, annually starting at age 50
- Skin Screening Conducted annually during wellness exam
- Colorectal Screening starting at age 50:
Colonoscopy Every 10 years
OR Cologuard Every 3 years
OR CT Colongraphy Every 5 years (restrictions apply)
*Hysterectomy Note: In some cases the pap smear may not be applicable, however, the physician still needs to note the reason on the exam form.
MALE
- Testicular Exam Conducted annually during wellness exam
- Skin Screening Conducted annually during wellness exam
- Colorectal Screening starting at age 50:
Colonoscopy Every 10 years
OR Cologuard Every 3 years
OR CT Colongraphy Every 5 years (resctrictions apply)
If the above screenings have already been completed according to the age guidelines given, you are not required to repeat. However, the date of the screening and the name of the physician must be completed on the Wellness Exam Form.
Mammogram Screenings
MAMMOGRAM:
- No co-pay for the mammogram screening and interpretation.
- Additional Medical Services – Cost Sharing: If the screening results in a medical condition and subsequent office visits are needed, then the member is responsible for co-pay, deductible and co-insurance according to the level of benefit (Basic, Better, or Best) at the time of service.
*The guidelines for the age-based screenings were determined According to the American Academy of Family Physicians (AAFP) and the American Cancer Society (ACS) recommendations.
MAMMOGRAPHY BASICS:
- A screening mammogram is an x-ray exam of the breast in a woman that has no symptoms. The goal of a screening mammogram is to find cancer when it is still too small to be felt by a woman or her doctor.
- A diagnostic mammogram is an x-ray exam of the breast in a woman who either has a breast complaint (breast mass, nipple discharge, etc.) or has had an abnormality found during a mammogram screening.
- See www.cancer.org for more info
NETWORK PROVIDERS:
Refer to the provider directory for a complete list of current providers
Provider Directory
Aetna Choice POSII (Open Access) Network
Search for: Other (X-ray, Surg Ctrs; Medical Equip, etc.)
Type: Radiology Center
Search in: Your Zip Code
Search in: Aetna Choice POSII (Open Access)
Skin Cancer Screenings
SKIN SCREENING:
It is the responsibility of the Primary Care Physician to conduct a Skin Screening during the Qualifying Wellness Exam.
- No co-pay for the screening when conducted during the Wellness Exam by your Primary Care Physician.
- Additional Health Services – Cost Sharing: If the screening results in a referral to a Specialist* or a medical condition and subsequent office visits are needed, then the member is responsible for co-pay, deductible and co-insurance according to the level of benefit (Basic, Better, or Best) at the time of service.
The guidelines for the age-based screenings were determined According to the American Academy of Family Physicians (AAFP) and the American Cancer Society (ACS) recommendations.
SKIN CANCER SCREENING:
The Skin Cancer Foundation Recommends a Professional Examination Annually
- The American Cancer Society recommends a cancer-related checkup by a physician, including skin examination, during a periodic health examination for people ages 20 and older.
- If an individual notices any signs it is recommended that he/she see their Primary Care Physician, a Dermatologist or Plastic Surgeon as soon as possible.
- Everyone should know their own pattern of moles, blemishes, freckles, and other marks on the skin so they can notice changes during monthly self-examinations.
- Key warning signs of non-melanoma skin cancers are a new growth, a spot that is getting larger, or a visible sore that does not heal within three months.
- For melanoma, the most important warning sign is a change in the size, shape, or color of a mole or signs that its border is becoming ragged. Other symptoms include scaliness, bleeding, or change in the appearance of a bump or nodule; the spread of pigmentation beyond its border; or a change in sensation, itchiness, tenderness, or pain. People who notice these kinds of signs should see a dermatologist or plastic surgeon immediately.
- Most skin cancers can be treated successfully if detected early, even melanoma, the most serious type of skin cancer.
- See: www.cancer.org www.aad.org and www.skincancer.org for more information.
NETWORK PROVIDERS:
*If referred to a specialist refer to the provider directory for a complete list of current providers. For Provider guidance contact a YourChoice Nurse Advocate at 748-4501 x6409 or x6411.
Provider Directory
Aetna Choice POSII (Open Access) Network
Search for: Medical Specialists
Type: Dermatology or Plastic Surgery
Search in: Your Zip Code
Select a Plan: Aetna Choice POSII (Open Access)
Colonoscopy Screening
Every 10 years starting at age 50 *Higher risk individuals may need to be tested earlier.
- No co-pay for the screening evaluation, the screening colonoscopy, or the prep medication.
- Additional Health Services – Cost Sharing: If the screening results in a medical condition and subsequent office visits are needed, then the member is responsible for co-pay, deductible and co-insurance according to the level of benefit (Basic, Better, or Best) at the time of service.
The guidelines for the age-based screenings were determined According to the American Academy of Family Physicians (AAFP) and the American Cancer Society (ACS) recommendations.
COLONOSCOPY BASICS
- Colonoscopy is a test using a scope and video that lets your health care professional examine the lining of your colon and rectum. Colonoscopy can detect polyps (growths on the lining of the colon or rectum) and early cancers. Removal of polyps, which generally can be performed during colonoscopy, can prevent colorectal cancer.
- Colonoscopy is an outpatient screening test performed at a hospital or a clinic. Health care professionals receive special training to perform the test.
- A gastroenterologist is a specialist in gastrointestinal diseases and has received special training in colonoscopy.
- No referral or authorization is required for a colonoscopy when an In-Network Gastroenterologist is seen.
- To qualify for the ULTIMATE and BEST Health Plan, Manatee YourChoice requires a screening colonoscopy every 10 years as recommended by the American Academy of Family Practice Physicians.
- See: www.preventcancer.org/colorectal for more information.
COLORECTAL CANCER
- Colorectal Cancer is the 2nd most common cancer killer in the United States, causing an estimated 56,000 deaths each year. More than 138,000 new cases of colorectal cancer are diagnosed each year. Men and women are equally affected.
- Colorectal cancer is a malignant growth in the colon and rectum. Most colon cancers arise from polyps (abnormal growths within the wall of the large intestines) that may become cancerous over time.
- All adults are at risk, and the risk increases with age. It is estimated that colon cancer will strike 1 in 10 couples during their lifetime.
- A study in the New England Journal of Medicine stated that more than 90% of deaths associated with colorectal cancer may be eliminated by early detection.
- When should you be screened for colorectal Cancer? - Every adult age 50 years and older
Are You at High Risk?
- Family history (parent or sibling) of colon cancer or adenomatous polyp
- Family history of Crohn's Disease or Ulcerative Colitis
NETWORK PROVIDERS:
Refer to the provider directory for a complete list of current providers. For Provider guidance contact a Nurse Advocate at 748-4501 x6409 or x6411.
Provider Directory
Aetna Choice POSII (Open Access) Network
Search for: Medical Specialists
Type: Gastroenterology
Search in: Your Zip Code
Select a Plan: Aetna Choice POSII (Open Access)