Use these guidelines to help maintain a healthy lifestyle

Mom and Son laughing

Screening: Children, birth to 18 years

Ask your child’s doctor about the frequency of well-child visits based on your child’s age. Generally, babies need to be seen at 2- to 3-month intervals; older children should be seen annually.

Age Screening Frequency
Newborn Genetic Metabolic Screening (Including PKU, sickle cell, blood disorders, hypothyroidism) Once
Newborn Hearing Assessment Once
Birth – 2 years Head Circumference At each well-child visit
6 – 12 months Iron Deficiency Anemia Once for prevention
Birth – 6 years Height/Length and Weight At each well-child visit
1, 2 and 3 years Lead Level Frequency dependent on risk
Younger than 5 years Vision Screening Once

 

Counseling: Children, birth to 18 years

As your child grows, talk with your child’s doctor about:
  • Nutrition: obesity and eating disorders
  • Physical activity and exercise
  • Safety, inside and outside the home:
    • Car seats
    • Seat belts
    • Poison prevention
    • Injury prevention
  • Child abuse
  • Sexuality and sexually transmitted diseases – Adolescents
  • Birth control – Adolescents
  • Tobacco, alcohol and drug use/abuse
  • Dental and oral health
  • Skin cancer: minimizing exposure to ultraviolet radiation

 

Immunizations: Children, birth to 2 years

The following immunizations are recommended for children in the first two years of life. Vaccine schedules may differ based on your child’s age and health when starting a series of injections. Ask your doctor how you should space your child’s appointments to get the best results from these vaccines to prevent serious communicable diseases.

Immunization Scheduling Information
Hepatitis B (HepB) 3 – 4 doses before child’s 2nd birthday; the first is usually at birth
Rotavirus (Rota) 2 doses before 6 months of age
Diphtheria, Tetanus, Pertussis (whooping cough) (DTaP) 4 doses before child’s 2nd birthday
Haemophilius Influenza Type B (Hib) 3 – 4 doses before child’s 2nd birthday
Pneumococcal (PCV) 4 doses before child’s 2nd birthday
Inactivated Poliovirus (IPV) 3 – 4 doses before child’s 2nd birthday
Influenza (Flu) 2 doses first flu season; annually after. Children over 2 years old can use nasal spray vaccine
Measles, Mumps, Rubella (MMR) Once 12 – 18 months
Varicella (Chicken pox) Once 12 – 18 months
Hepatitis A (HepA) 2 doses after 12 months of age; high risk children only

 

Immunizations: Children, 2 years to 18 years

The following immunizations are recommended for children from 2 to 18 years old. Children who have not received their vaccines earlier in life can receive a “catch-up” series. Vaccine schedules may differ based on your child’s age and health when starting a series of injections. Ask your doctor how you should space your child’s appointments to get the best results from these vaccines to prevent serious communicable diseases.

Immunization Scheduling information
Hepatitis B (HepB) HepB catch up series
Diphtheria, Tetanus, Pertussis (whooping cough) (DTaP) One at 4 – 6 years old; one at 11 – 12 years old; one every 10 years thereafter
Human Papillomavirus (HPV) Quadravalent vaccine 3-dose series, 9 – 18 years old
Pneumococcal (PCV) PCV catch-up series
Inactivated Poliovirus (IPV) IPV catch-up series
Influenza (Flu) Annually; children over 2 years of age can receive nasal spray vaccine
Measles, Mumps, Rubella (MMR) Once at 4 – 6 years old or catch-up
Varicella (Chicken pox) Once at 4 – 6 years old or catch-up
Hepatitis A (HepA) Catch-up series
Meningococcal 2 – 6 years old; high risk children only; one 11 – 12 years old; catch-up

 

Preventive Guidelines: Adults, 18 years and older

The following preventive services are recommended on an annual basis or during the age ranges noted. Ask your physician about your individual needs for screening for early detection of serious illness.

Screening Services Frequency/Age Range
History, Physical Examination and Assessment:
  • Blood Pressure
  • Height and Weight (BMI)
  • Depression Screening
  • Tobacco, Alcohol or Drug Abuse Screening
  • Sexual Wellness and Disease Screening
At each preventive visit
Diabetes Screening At each preventive visit
Cholesterol Screening Every 5 years beginning at age 35
Colorectal Cancer 50 years of age and over; annually with fecal occult blood test; every 5 - 10 years with colonoscopy
Cervical Cancer Screening (Pap smear) Women annually at age 18 or age of sexual activity and every 1 – 3 years thereafter
Breast Cancer Screening (Mammogram) Women age 40 and older; every 1 – 2 years thereafter
Osteoporosis Screening Age 65 and older; once every 2 years thereafter
Pregnancy-related Screenings:
  • Bacteria in the urine
  • Folic acid supplementation
  • Hepatitis B screening
  • Rh compatibility
  • Iron deficiency screening
Ask your doctor about additional services recommended during your pregnancy
Risk of Falling Assessment Age 65 and older
Hepatitis C Virus Infection, Screening Once for adults born between 1945 and 1965

 

Counseling: Adults, 18 years and older

Talk with your doctor about a referral to a specialist if you have issues with:
  • Physical activity and exercise
  • Calcium intake
  • Tobacco, alcohol and drug use/abuse
  • Nutrition: obesity and eating disorders
  • Safety: Sun exposure, seat belt use, fall and injury prevention
  • Genetic disorders
  • Interpersonal and domestic violence
  • Sexually transmitted disease
  • Risk of falling, mobility problems (age 65 and older)

 

Immunizations: Adults, 18 years and older

Tetanus and Diphtheria (Td/Tdap) Every 10 years
Pneumococcal (Pneumonia) One dose
Influenza (Flu) Annually
Human Papilloma Virus (HPV) 3-dose series before age 25
Zoster (Shingles) One dose, age 60 or over
Meningococcal Certain high risk groups based on medical, occupational, lifestyle, or other indications
Hepatitis B or Hepatitis A Persons at risk or catch-up series
Varicella (Chicken pox) Catch-up if needed

 

Mom and Son laughing

Screening: Children, birth to 18 years

Ask your child’s doctor about the frequency of well-child visits based on your child’s age. Generally, babies need to be seen at 2- to 3-month intervals; older children should be seen annually.

Age Screening Frequency
Newborn Genetic Metabolic Screening (Including PKU, sickle cell, blood disorders, hypothyroidism) Once
Newborn Hearing Assessment Once
Birth – 2 years Head Circumference At each well-child visit
6 – 12 months Iron Deficiency Anemia Once for prevention
Birth – 6 years Height/Length and Weight At each well-child visit
1, 2 and 3 years Lead Level Frequency dependent on risk
Younger than 5 years Vision Screening Once

 

Counseling: Children, birth to 18 years

As your child grows, talk with your child’s doctor about:
  • Nutrition: obesity and eating disorders
  • Physical activity and exercise
  • Safety, inside and outside the home:
    • Car seats
    • Seat belts
    • Poison prevention
    • Injury prevention
  • Child abuse
  • Sexuality and sexually transmitted diseases – Adolescents
  • Birth control – Adolescents
  • Tobacco, alcohol and drug use/abuse
  • Dental and oral health
  • Skin cancer: minimizing exposure to ultraviolet radiation

 

Immunizations: Children, birth to 2 years

The following immunizations are recommended for children in the first two years of life. Vaccine schedules may differ based on your child’s age and health when starting a series of injections. Ask your doctor how you should space your child’s appointments to get the best results from these vaccines to prevent serious communicable diseases.

Immunization Scheduling Information
Hepatitis B (HepB) 3 – 4 doses before child’s 2nd birthday; the first is usually at birth
Rotavirus (Rota) 2 doses before 6 months of age
Diphtheria, Tetanus, Pertussis (whooping cough) (DTaP) 4 doses before child’s 2nd birthday
Haemophilius Influenza Type B (Hib) 3 – 4 doses before child’s 2nd birthday
Pneumococcal (PCV) 4 doses before child’s 2nd birthday
Inactivated Poliovirus (IPV) 3 – 4 doses before child’s 2nd birthday
Influenza (Flu) 2 doses first flu season; annually after. Children over 2 years old can use nasal spray vaccine
Measles, Mumps, Rubella (MMR) Once 12 – 18 months
Varicella (Chicken pox) Once 12 – 18 months
Hepatitis A (HepA) 2 doses after 12 months of age; high risk children only

 

Immunizations: Children, 2 years to 18 years

The following immunizations are recommended for children from 2 to 18 years old. Children who have not received their vaccines earlier in life can receive a “catch-up” series. Vaccine schedules may differ based on your child’s age and health when starting a series of injections. Ask your doctor how you should space your child’s appointments to get the best results from these vaccines to prevent serious communicable diseases.

Immunization Scheduling information
Hepatitis B (HepB) HepB catch up series
Diphtheria, Tetanus, Pertussis (whooping cough) (DTaP) One at 4 – 6 years old; one at 11 – 12 years old; one every 10 years thereafter
Human Papillomavirus (HPV) Quadravalent vaccine 3-dose series, 9 – 18 years old
Pneumococcal (PCV) PCV catch-up series
Inactivated Poliovirus (IPV) IPV catch-up series
Influenza (Flu) Annually; children over 2 years of age can receive nasal spray vaccine
Measles, Mumps, Rubella (MMR) Once at 4 – 6 years old or catch-up
Varicella (Chicken pox) Once at 4 – 6 years old or catch-up
Hepatitis A (HepA) Catch-up series
Meningococcal 2 – 6 years old; high risk children only; one 11 – 12 years old; catch-up

 

Preventive Guidelines: Adults, 18 years and older

The following preventive services are recommended on an annual basis or during the age ranges noted. Ask your physician about your individual needs for screening for early detection of serious illness.

Screening Services Frequency/Age Range
History, Physical Examination and Assessment:
  • Blood Pressure
  • Height and Weight (BMI)
  • Depression Screening
  • Tobacco, Alcohol or Drug Abuse Screening
  • Sexual Wellness and Disease Screening
At each preventive visit
Diabetes Screening At each preventive visit
Cholesterol Screening Every 5 years beginning at age 35
Colorectal Cancer 50 years of age and over; annually with fecal occult blood test; every 5 - 10 years with colonoscopy
Cervical Cancer Screening (Pap smear) Women annually at age 18 or age of sexual activity and every 1 – 3 years thereafter
Breast Cancer Screening (Mammogram) Women age 40 and older; every 1 – 2 years thereafter
Osteoporosis Screening Age 65 and older; once every 2 years thereafter
Pregnancy-related Screenings:
  • Bacteria in the urine
  • Folic acid supplementation
  • Hepatitis B screening
  • Rh compatibility
  • Iron deficiency screening
Ask your doctor about additional services recommended during your pregnancy
Risk of Falling Assessment Age 65 and older
Hepatitis C Virus Infection, Screening Once for adults born between 1945 and 1965

 

Counseling: Adults, 18 years and older

Talk with your doctor about a referral to a specialist if you have issues with:
  • Physical activity and exercise
  • Calcium intake
  • Tobacco, alcohol and drug use/abuse
  • Nutrition: obesity and eating disorders
  • Safety: Sun exposure, seat belt use, fall and injury prevention
  • Genetic disorders
  • Interpersonal and domestic violence
  • Sexually transmitted disease
  • Risk of falling, mobility problems (age 65 and older)

 

Immunizations: Adults, 18 years and older

Tetanus and Diphtheria (Td/Tdap) Every 10 years
Pneumococcal (Pneumonia) One dose
Influenza (Flu) Annually
Human Papilloma Virus (HPV) 3-dose series before age 25
Zoster (Shingles) One dose, age 60 or over
Meningococcal Certain high risk groups based on medical, occupational, lifestyle, or other indications
Hepatitis B or Hepatitis A Persons at risk or catch-up series
Varicella (Chicken pox) Catch-up if needed

 

Sources:

ahrq.gov, website of U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, accessed 8/31/13.

www.cdc.gov/vaccines/pubs/acip-list.htm, website of U.S. Department of Health and Human Services, Center for Disease Control and Prevention, accessed 11/4/10.

These guidelines are for informational purposes only. BCBSNE does not diagnose conditions or recommend specific treatment. The information provided in this document is not a substitute for your physician’s care. The Patient Protection and Affordability Care Act (PPACA) went into effect for plan/policy years on and after September 23, 2010. Preventive services covered under this act must be submitted with the appropriate diagnosis and procedure code in order to be paid at the 100% benefit level. Preventive services do not generally include services intended to treat an existing illness, injury, or condition. Benefits will be determined based on how the provider submits the bill. If during your preventive services visit you receive services to treat an existing illness, injury or condition, you may be required to pay a copay, deductible and/or coinsurance for those covered services. Individual and Group health plans vary in the preventive benefits covered. Refer to your Individual Contract and/or Endorsement, Master Group Contract, Certificate of Coverage or Summary Plan Description for details on how your preventive services benefits are covered.

HEALTH INSURANCE TERMS


COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy


in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.