Preventive care guidelines for children and adults.

Transcription

1 Preventive care guidelines for children and adults.

2 Keeping a focus on regular preventive care can help you and your family stay healthy. Preventive care can help you avoid potentially serious health conditions and/or obtain early diagnosis and treatment. Generally, the sooner your doctor can identify and treat a medical condition, the better the outcome. Under the Affordable Care Act (ACA), 1 you can get certain preventive health care services, covered at 100 percent, without any cost to you. Just obtain your preventive care from a health plan network provider. Diagnostic (non-preventive) services are also covered, but you may have to pay a copayment, coinsurance or deductible. Check your plan documents to make sure.

3 Preventive care guidelines for children. 2 Recommended preventive care services for children will vary based on age and may include some of the following: Age-appropriate well-child examination. Measurement of your child s head size. Measurement of your child s length/height and weight. Metabolic screening panel for newborns. Screening blood tests, if appropriate. Age-appropriate immunizations. Vision screening, by primary care physician. Oral health risk assessment. Fluoride application and/or oral supplements, under certain circumstances. Hearing screening. Autism screening. Lead screening, for children under age 7. Counseling on the harmful effects of smoking and illicit use of drugs (children and adolescents). Counseling for children and their parents on promoting a healthy diet and exercise. Screening certain children at high risk for sexually transmitted diseases, lead, depression, tuberculosis and more. Evaluating the need for iron supplements. Not all children require all of the services identified above. Your doctor should give you information about your child s growth, development and general health, and answer any questions you may have. Help protect and maintain your child s health with regular preventive care visits with a network doctor. 1

4 Preventive care immunization guidelines for children and adolescents 18 years or younger. Immunizations can help protect your child against many childhood diseases. The following immunization schedule provided by the Centers for Disease Control and Prevention (CDC) will provide you with the guideline recommendations for children 18 years or younger. Vaccine Hepatitis B (HepB) Rotavirus (RV) RV1 (2- series); RV5 (3- series) Diphtheria, tetanus, & acellular pertussis (DTaP: <7 yrs) Haemophilus influenzae type b (Hib) Pneumococcal conjugate (PCV13) Inactivated poliovirus (IPV: <18 yrs) Birth 1st 1 mo 2 mos 2nd 1st 1st 1st 1st 1st 4 mos 2nd 2nd 2nd 2nd 2nd 6 mos 3rd 3rd 9 mos 12 mos 3rd 15 mos 3rd or 4th 3rd 4th Influenza (IIV) Annual vaccination (IIV) 1 or 2 s Annual vaccination (IIV) 1 only Measles, mumps, rubella (MMR) Varicella (VAR) 1st 1st 4th 18 mos mos 2 3 yrs 4 6 yrs 5th 4th 2nd 2nd 7 10 yrs yrs yrs 16 yrs yrs Hepatitis A (HepA) 2- series Meningococcal (Hib-MenCY >6 weeks; MenACWY-D >9 mos; MenACWY-CRM 2 mos) Tetanus, diphtheria, & acellular pertussis (Tdap: >7 yrs) Human papillomavirus (HPV) 1st Tdap 2nd Meningococcal B Pneumococcal polysaccharide (PPSV23) No recommendation. Range of recommended ages for catch-up immunization. Range of recommended ages for all children. School entry and adolescent vaccine age groups. Range of recommended ages for non-high-risk groups that may receive vaccine, subject to individual clinical decision making. Range of recommended ages for certain high-risk groups. If your child has any medical conditions that put him or her at risk for infection or is traveling outside of the United States, talk to your child s doctor about additional vaccines that he or she may need. Note: If your child misses a shot, talk with your child s doctor for his or her direction and to answer any questions about vaccines. For more information about vaccines, visit cdc.gov/vaccines. 2

5 Preventive care screening guidelines and counseling services for adults. 2 A preventive health visit can help you see how healthy you are now and help identify any health issues before they become more serious. You and your doctor can then work together to choose the care that may be right for you. Recommended preventive care services may include the following: For adult men: Wellness examinations. Abdominal Aortic Aneurysm Screening for age years who have ever smoked. Alcohol Screening and Brief Counseling screening during wellness examinations. Brief counseling interventions for certain patients. Blood Pressure Screening at each wellness examination. Certain patients may also require ambulatory blood pressure measurements outside of a clinical setting. Check with your doctor. Cholesterol Screening for age years. Colorectal Cancer Screening for age years. Ask your physician about screening methods and intervals for screening. Depression Screening for all adults, in a primary care setting. Diabetes Screening for age years who are overweight or obese. Falls Prevention Counseling during wellness examination, for community-dwelling older adults. Healthy Diet Behavioral Counseling for persons with cardiovascular disease risk factors, in a primary care setting. Hepatitis B Virus Infection Screening for persons at high risk. Hepatitis C Virus Infection Screening one time screening for adults born between , or, persons at high risk. Human Immunodeficiency Virus (HIV) Screening. Immunizations FDA approved and have explicit ACIP recommendations for routine use. Latent Tuberculosis Infection Screening for persons at increased risk. Lung Cancer Screening with Low-Dose CT Scan for age years with at least a 30 pack-year smoking history (requires prior authorization). Obesity Screening and Counseling at each wellness examination. Certain patients may need medical nutrition therapy. Sexually Transmitted Infections, Behavioral Counseling to Prevent behavioral counseling for adults who are at increased risk, in a primary care setting. Skin Cancer, Behavioral Counseling to Prevent at each wellness examination, for young adults up to age 24 years. Syphilis Screening for adults at increased risk. Tobacco Cessation, Screening, Behavioral Counseling screening, and behavioral counseling for adults who smoke, in a primary care setting (refer to pharmacy vendor for pharmacotherapy for tobacco cessation). 3

6 For adult women: Wellness Examinations, Well-Woman Visits well-woman visits, including routine, low-risk prenatal visits. Abdominal Aortic Aneurysm Screening for age years who have ever smoked. Alcohol Screening and Brief Counseling screening during wellness examinations. Brief counseling interventions for certain patients. Bacteriuria Screening during pregnancy. Blood Pressure Screening at each wellness examination. Certain patients may also require ambulatory blood pressure measurements outside of a clinical setting. Check with your doctor. Breastfeeding Primary Care Interventions, Counseling, Support and Supplies during pregnancy and after birth. Includes personal use electric breast pump. Cervical Cancer Screening (Pap Smear) women age years old. Chemoprevention of Breast Cancer, Counseling for women at high risk of breast cancer, but low risk for adverse effects. Chlamydia and Gonorrhea Infection Screening for sexually active women age 24 and younger, and older women at increased risk. Cholesterol Screening for age years. Colorectal Cancer Screening for age years. Ask your physician about screening methods and intervals for screening. Contraceptive Methods (Including Sterilizations) FDAapproved methods of contraception for women, including patient education and counseling. Depression Screening for all adults, in a primary care setting. Diabetes Screening for age years who are overweight or obese. Falls Prevention Counseling during wellness examination, for community-dwelling older adults. Genetic Counseling and Evaluation for BRCA Testing, and BRCA Lab Testing lab testing requires prior authorization. Gestational Diabetes Mellitus Screening during pregnancy. Healthy Diet Behavioral Counseling for persons with cardiovascular disease risk factors, in a primary care setting. Hepatitis B Virus Infection Screening for persons at high risk. Hepatitis C Virus Infection Screening one-time screening for adults born between , or, persons at high risk. Human Immunodeficiency Virus (HIV) Screening for all adults. Human Papillomavirus DNA Testing for women age Immunizations FDA approved and have explicit ACIP recommendations for routine use. Intimate Partner Violence, Interpersonal and Domestic Violence, Counseling and Screening during wellness examination. Latent Tuberculosis Infection Screening for persons at increased risk. Lung Cancer Screening with Low-Dose CT Scan for age years with at least a 30 pack-year history (with prior authorization). Mammography Screening. Obesity Screening and Counseling at each wellness examination. Certain patients may need medical nutrition therapy. Osteoporosis Screening women age 65 and older, and younger women at increased risk. Rh Incompatibility Screening during pregnancy. Sexually Transmitted Infections, Behavioral Counseling to Prevent behavioral counseling for adults who are sexually active or otherwise at increased risk, in a primary care setting. Skin Cancer, Behavioral Counseling to Prevent at each wellness examination, for young adults up to age 24 years. Syphilis Screening for adults at increased risk. Tobacco Cessation, Screening, Behavioral Counseling screening, and behavioral counseling for adults who smoke, in a primary care setting (refer to pharmacy vendor for pharmacotherapy for tobacco cessation). 4

7 Preventive care immunization guidelines for adults. Immunizations may help protect against many illnesses and diseases. The following immunization schedule provided by the Centers for Disease Control and Prevention (CDC) will give you the recommendations for adults aged 19 years or older. Vaccine years years years years 65 years Influenza (flu shot) 1 annually Tetanus, Diphtheria, Pertussis Vaccine Td/Tdap Substitute Tdap for Td once, then Td booster every 10 yrs Measles, Mumps, Rubella MMR 1 or 2 s depending on indication Varicella (Chicken Pox) 2 s Herpes Zoster Vaccine (Shingles) Shingrix 2 s, separated by 2 6 months Herpes Zoster Vaccine (Shingles) Zostavax 1 Human Papilloma Virus (HPV) Female 3 s Human Papilloma Virus (HPV) Male 3 s Pneumococcal Conjugate Vaccine PCV13 Pneumococcal Polysaccharide Vaccine PPSV23 1 or 2 s depending on indication 1 Hepatitis A HepA 2 or 3 s depending on vaccine Hepatitis B HepB 3 s Meningococcal Vaccine MenACWY or MPSV4 1 or more s depending on indication Meningitis B MenB 2 or 3 s depending on vaccine Haemophilus Influenzae Type B Hib 1 or 3 s depending on indication No recommendation. Recommended for adults who meet the age requirement, lack documentation of vaccination, or lack evidence of past infection. Recommended for adults with additional medical conditions or other indications. The recommendations in this schedule were approved by the Centers for Disease Control and Prevention s (CDC) Advisory Committee on Immunization Practices (ACIP). 5

8 For more information about preventive guidelines for your age and gender, visit uhc.com/preventive care. 1 Under the Patient Protection and Affordable Care Act (PPACA), many plans are required to cover certain preventive services without cost share for members. Always refer to your plan documents for specific benefit coverage and limitations or call the toll-free member phone number on your health plan ID card. 2 These guidelines are based, in part, on the requirements of the Patient Protection and Affordable Care Act, and recommendations of the U.S. Preventive Services Task Force (USPSTF), the Health Resources & Services Administration (HRSA) of the U.S. Department of Health and Human Services, and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). Individuals with symptoms or at high risk for disease may need additional services or more frequent interventions that may not be covered as a preventive benefit. These guidelines do not necessarily reflect the vaccines, screenings or tests that will be covered by your benefit plan. These clinical guidelines are provided for informational purposes only, and do not constitute medical advice. Preventive care benefits may not apply to certain services listed above. Always refer to your plan documents for specific benefit coverage and limitations or call the toll-free member phone number on your health plan ID card. Source: Source: Source: Centers for Disease Control and Prevention, Recommended immunization schedules for children and adolescents aged 18 years or younger - United States, 2018, at: Development, psychosocial and chronic disease issues for children and adolescents may require frequent counseling and treatment visits separate from preventive care visits. These guidelines represent a consensus by the American Academy of Pediatrics (AAP) and Bright Futures. The recommendations in this statement do not indicate an exclusive course of treatment or standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Discuss with your doctor how these guidelines may be right for your child, and always consult your doctor before making any decisions about medical care. These clinical guidelines are provided for informational purposes only, and do not constitute medical advice. Preventive care benefits may not apply to certain services listed above. Always refer to your plan documents for your specific coverage. Additional information about the vaccines in this schedule, extent of available data, including a full list of footnotes and contraindications for vaccination is also available at cdc.gov/vaccines or from the CDC-INFO Contact Center at CDC-INFO ( ) in English and Spanish, 8 a.m. 8 p.m. Eastern Time, Monday Friday, excluding holidays. For a complete list of footnote references, please visit: cdc.gov/vaccines/schedules/downloads/adult/adult-schedule.pdf. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Health Plan coverage provided by or through a UnitedHealthcare company. Facebook.com/UnitedHealthcare Twitter.com/UHC Instagram.com/UnitedHealthcare YouTube.com/UnitedHealthcare MT / United HealthCare Services, Inc A

9 1 New Prescription Mail-In Order Form Member and physician information please use black or blue ink. One form per member. Member ID Number (Additional coverage, if applicable) Secondary Member ID Number Last Name First Name MI Delivery Address Apt. # City State ZIP Phone Number with Area Code Date of Birth (mm/dd/yyyy) Physician Name Gender M F Physician Phone Number with Area Code 2 Health history Medication Allergies: Aspirin Erythromycin Quinolones Others: None known Cephalosporins NSAIDs Sulfa Amoxil/Ampicillin Codeine Penicillin Tetracyclines Health Conditions: Asthma Glaucoma High cholesterol Others: None known Cancer Heart condition Osteoporosis Arthritis Diabetes High blood pressure Thyroid Disease Over-the-counter/herbal medications taken regularly: 3 Pharmacy processing Generic substitution. FDA-approved generic equivalents will be dispensed for brand-name drugs whenever possible, unless you or your physician indicate otherwise. Brand-name medications may be subject to a higher cost. If you require brand-name medications, please list those medications here: Keep on file. If you are including any prescriptions that you want to keep on file for shipment at a later date, please list them here: Notes to pharmacy: 4 Payment and shipping information do not send cash Standard delivery is included at no charge. New prescriptions should arrive within about 10 business days from the date the completed order is received. Completed refill orders should arrive within about 7 business days. OptumRx will contact you if there will be an extended delay in delivering your medications. You may log on to to see if drug pricing information is available before enclosing payment. Once shipped, medications may not be returned for a refund or adjustment. Ship overnight. Add $12.50 to New Credit Card Number order amount (subject to change). 5 Check enclosed. All checks must be signed and made payable to: OptumRx. Charge to my credit card on file. Charge to my NEW credit card. Expiration Date (Month/Year) Visa, MasterCard, AMEX and Discover are accepted. Signature: Date: For new prescription orders and maintenance refills, this credit card will be billed for copay/coinsurance and other such expenses related to prescription orders. By supplying my credit card number, I authorize OptumRx to maintain my credit card on file as payment method for any future charges. To modify payment selection, contact customer service at any time. Mail this completed order form with your new prescription(s) to OptumRx, P.O. Box 2975, Mission, KS DO NOT STAPLE OR TAPE PRESCRIPTIONS TO THE ORDER FORM. ORX5633-UHCEI_ /13 NRX001

10 Tools Tools Virtual Virtual Visits Visits Sick with the flu? See a doctor whenever, wherever. When you re sick and need care quick, a Virtual Visit is a convenient way to start feeling better faster. With a Virtual Visit, you can see and talk to a doctor via mobile device or computer 24/7, no appointment needed. The doctor can give you a diagnosis and prescription*, if needed. And with a UnitedHealthcare plan, your cost is $50 or less. To get started with a Virtual Visit, go to uhc.com/virtualvisits. Get care in 20 minutes or less. Use a Virtual Visit for these minor medical needs: Bladder infection/urinary tract infection Bronchitis Cold/flu Fever Pinkeye Health plan ID card Credit card Pharmacy location Rash Sinus problems Sore throat Stomachache Prepare for your Virtual Visit. Have these three items ready to register and complete your Virtual Visit: Virtual Visits can save time and money. An estimated 25 percent of ER visits could be treated with a Virtual Visit which brings a potential $1,700 cost down to $50.** * Prescription services may not be available in all states. ** Based on analysis of 2016 UnitedHealthcare ER claim volumes, where ER visits are low-acuity and could be treated in a Virtual Visit, PCP, or urgent/convenient care setting. Virtual visits are not an insurance product, health care provider or a health plan. Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times or in all locations. The Designated Virtual Visit Provider s reduced rate for a virtual visit is subject to change at any time. Insurance coverage provided by or through UnitedHealthcare Insurance Company and its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Health Plan coverage provided by or through a UnitedHealthcare company. Facebook.com/UnitedHealthcare Twitter.com/UHC Instagram.com/UnitedHealthcare YouTube.com/UnitedHealthcare MT / United HealthCare Services, Inc

11 Using your pharmacy benefit

12 Your pharmacy benefit services OptumRx is your plan s pharmacy services manager and is committed to helping you find cost-effective ways to get your medication(s). Set up your online account Once registered on our website, access the pharmacy section by clicking Manage My Prescriptions to: Manage your home delivery medications. Set up or text message 1 reminders. Check your order status. Use the UnitedHealthcare Health4Me app Manage your prescription benefit and home delivery orders with the Health4Me app on your smartphone or tablet. Use a network pharmacy Be sure to fill your prescriptions at a network pharmacy, otherwise they may not be covered or you may pay more. Finding a network pharmacy is easy: Log in to myuhc.com, then choose select Manage My Prescriptions. Or, use the Health4Me app. Or call the number on the back of your health plan ID card. Need more information? Visit myuhc.com to learn more. 2

13 Home delivery from OptumRx Use OptumRx home delivery to help manage the medications you take regularly. Home delivery is safe, reliable and offers the following advantages: Cost savings You may pay less for your medication with a three-month supply through OptumRx. Convenience Get free standard shipping on medications delivered to your mailbox. 24/7 access and reminders Speak to a pharmacist who can answer questions any time, any day. Even set up text and reminders to help you remember to take or refill your medications. Make the choice to use home delivery By going online: Visit myuhc.com, register and follow the simple step-by-step instructions. By phone: Call the member phone number on the back of your plan ID card. It s helpful to have your plan ID card and medication bottle available. By eprescribe: Ask your doctor to send an electronic prescription. If you need your medication right away, ask your doctor for a one-month prescription to fill at a local pharmacy and a three-month prescription you can use to set up home delivery. Log on to myuhc.com see if you could save. Or use the Health4Me app. 3

14 Making medication decisions Use the UnitedHealthcare prescription drug list (PDL) The PDL is a list of your plan s covered medications. The medications are organized into cost tiers. Choosing medications in lower tiers may save you money. Cost tier Includes Helpful tips $ Tier 1 Lowest cost $$ Tier 2 Mid-range cost $$$ Tier 3 Highest cost Lower-cost medications. Some brand-name medications. Mix of brand-name and generic medications. Highest cost brand-name medications and some generic medications. Tier 1 medications have the lowest out-of-pocket costs. Consider generic alternatives. Tier 2 drugs may cost less than Tier 3 drugs. Many Tier 3 medications have lower-cost options in Tiers 1 or 2. Ask your doctor if they could work for you. Save money Generic medications usually have a lower co-pay than brand name medications. Ask your doctor if there is a generic alternative for you. Compare prices Search for lower-cost alternatives. Just log in to myuhc.com, click on Manage My Prescriptions and select Drug Pricing. Or use the Health4Me app. Need more information? Visit myuhc.com to learn more. 4

15 Tips Know your plan Your plan may require one or more of the following for your prescription to be covered: Prior authorization approval to get a medication. Step therapy trying one medication before another. Quantity limits only a certain amount of the medication is allowed for coverage. Check your prescription drug list (PDL) Your PDL is a list of covered medications. The list is broken into sections called tiers. Choosing medications in lower tiers may save you money. Check your PDL often. Talk to your doctor When you talk with your doctor, use the Health4Me app to confirm coverage and costs. You can also talk about what you need to do to get your medication. Log on to myuhc.com see if you could save. Or use the Health4Me app. 5

16 Your plan may also include Mail Service Member Select Your plan may include the cost-saving medication home delivery program below. If your plan includes Mail Service Member Select, you are allowed a limited number of refills at your current pharmacy; then you must take action: Program name Mail Service Member Select Action needed: Choose to use OptumRx home delivery or stay at your retail pharmacy. If you choose to continue at your retail pharmacy, you must let OptumRx know your choice. Hassle-Free SM Fill The Hassle-Free Fill program provides automatic refills for eligible maintenance medication if you use home delivery. When it s time to refill, OptumRx will automatically: Call to notify you that your medication will ship soon (unless you cancel it within three business days of the refill notice). Bill your credit card for any copay, coinsurance or amount due. BriovaRx, the OptumRx specialty pharmacy You may be able to use BriovaRx, the OptumRx specialty pharmacy. BriovaRx is more than just a way for you to get your specialty medications. We provide ongoing support to help you manage more complicated conditions. Need more information? Visit myuhc.com to learn more. 6

17 Log on to myuhc.com see if you could save. Or use the Health4Me app. 7

18 Visit myuhc.com to get the most out of your pharmacy benefit. myuhc.com 1 OptumRx provides this service at no cost. Standard message and data rates charged by your carrier may apply. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Health plan coverage provided by or through a UnitedHealthcare company. OptumRx, Inc. is an affiliate of UnitedHealthcare Insurance Company /16 Consumer 2016 United HealthCare Services, Inc. UHC7511_160802