Preventive Health Guidelines

As of April 2011

What is your plan for better health?

Your health plan may help pay for tests to find disease early and routine wellness exams to help you and your family stay well.

Use this guide to know when to set up visits with your doctor for you and your children. Talk with your doctor (health care provider) about the care that is right for you.

Your plan may not pay for all services and treatments in this guide. To learn more about what your plan pays for, log in to see your certificate of coverage or call customer care.

This guide is just for you to learn from, it is not meant to take the place of medical care or advice.

Select a guideline to view:

Well-baby exam — birth to 2 years*: Infants who leave the hospital less than two days (48 hours) after birth need to be seen by a doctor within two to four days after being born. Also, you might want to talk to a doctor before your baby is born. You might talk to the doctor if you are a first-time parent, are having a high-risk pregnancy, or want to learn about feeding, circumcision or well-baby care. At the well-baby exam you may get advice on your child's safety, health, healthy eating and development. At these exams, your baby may get vaccines and these screenings:

	Age (in months)
Screenings	birth	1	2	4	6	9	12	15	18	24
Hearing	as a newborn and when your doctor suggests
Weight, length and head circumference (the length around the head)	at each visit
Hemoglobin or hematocrit (blood count)						Once between 9 and 12
Lead testing unless you are sure the child has not been around lead							at 12			at 24
Development and behavior	at each visit
Oral/dental health					at 6	at 9	at 12		at 18	at 24
Autism									at 18	at 24

	Age (in months)
Suggested Vaccines*	birth	1-2	2	4	6	6-18	12-15	15-18	19-23
Hepatitis B	✓	✓		See note		✓
Rotavirus (RV)**			✓ 2-dose or 3-dose series**
Diphtheria, tetanus, pertussis (DTaP)			✓	✓	✓			✓
Haemophilus influenza type b (Hib)****	✓ 3-dose or 4-dose series***
Pneumococcal conjugate (PCV)			✓	✓	✓		✓
Inactivated polio virus (IPV)			✓	✓		✓
Influenza (Flu)					✓ each year
Measles, mumps, rubella (MMR)							✓
Varicella (chicken pox)							✓
Hepatitis A							✓ 2-dose series

✓ Shows when vaccines are suggested

Note: Get this vaccine at this age, only if the combination vaccine is used after the birth dose.

Flu - Refer to flu.gov or cdc.gov to learn more about this vaccine.

Pneumococcal conjugate (PCV) -The suggested vaccine has changed. Children 14 to 59 months who had all of the PCV vaccine series, may need an extra vaccine shot at their next visit.

Children 14 to 59 months who had all of the PCV vaccine series with 7-valent pneumococcal conjugate vaccine (PCV7) should get 1 more dose of 13-valent pneumococcal conjugate vaccine (PCV13) at their next visit.

* This guide is for people with average risk. Some people may be at higher risk for health issues due to their family health history, their race or ethnicity, or other reasons. Talk to your doctor if you have concerns about your health.

**Rotavirus – 2-dose or 3-dose series; depends on brand of vaccine used

***Haemophilus influenza type b (Hib) – 3-dose or 4-dose series; depends on brand of vaccine used

Sources

American Academy of Family Physicians	Advisory Committee on Immunization Practices	American Cancer Society	Centers for Disease Control and Prevention
American Academy of Pediatrics	American College of Obstetrics and Gynecology	Adult Treatment Panel III/National Cholesterol Education Program	U.S. Preventive Services Task Force

Well-child exam — ages 2 ½ to 10 years*: You may get advice about how to keep your child safe, how to prevent injuries, good health, healthy eating and development. At ages 3 and 6, a referral to a dentist may be suggested. At these well-child exams, your child may get vaccines and these screenings:

	Age (in years)
Screenings	2 ^1/2	3	4	5	6	7	8	9	10
Blood pressure	each year starting at 3 years
Vision	each year
Hearing	each year
Height, weight, body mass index (BMI)**	each year
Development and behavior	at each visit
Oral/dental health	at 2 ^1/2

**Height and weight is used to find BMI. BMI for children is based on gender and age. It is used to see if a person is underweight, overweight or at risk for overweight.

	Age (in years)
Suggested Vaccines*	2 ^1/2	3	4	5	6	7-10
Diphtheria, tetanus, pertussis (DTaP)			✓ once between 4 and 6
Inactivated polio virus (IPV)			✓ once between 4 and 6
Influenza (Flu)	✓ each year
Measles, mumps, rubella (MMR)			✓ once between 4 and 6
Varicella (chicken pox)			✓ once between 4 and 6

✓ Shows when vaccines are suggested

Flu - Refer to flu.gov or cdc.gov to learn more about this vaccine.

* This guide is for people with average risk. Some people may be at higher risk for health issues due to their family health history, their race or ethnicity, or other reasons. Talk to your doctor if you have concerns about your health.

Sources

American Academy of Family Physicians	Advisory Committee on Immunization Practices	American Cancer Society	Centers for Disease Control and Prevention
American Academy of Pediatrics	American College of Obstetrics and Gynecology	Adult Treatment Panel III/National Cholesterol Education Program	U.S. Preventive Services Task Force

Well-child exam — ages 11 to 18 years*: The doctor may talk to you about health and wellness issues. These include healthy eating, exercise, healthy weight, how to prevent injuries, avoiding tobacco, alcohol and drugs, sexual behavior, dental health, mental health and secondhand smoke. At these exams, your child may get vaccines and these screenings:

	Age (in years)
Screenings	11	12	13	14	15	16	17	18
Blood pressure	each year
Vision	each year
Hearing	each year
Height, weight, body mass index (BMI)**	each year
Chlamydia	for sexually active women aged 25 and younger
Development and behavior	each year

**Height and weight is used to find BMI. BMI for children is based on gender and age. It is used to see if a person is underweight, overweight or at risk for overweight. BMI for adults is used to see if a person is underweight or obese.

	Age (in years)
Suggested Vaccines*	11-12	13-18
Tetanus, diphtheria, pertussis (Td/Tdap)	✓
Influenza (Flu)	✓ each year
Human papillomavirus (HPV)	✓ 3-dose (series)
Meningococcal	✓

✓ Shows when vaccines are suggested

Tdap (teens) If you are 13 to 18 years of age and have not had this vaccine before, talk to your doctor about a catch-up vaccine.

Flu - Refer to flu.gov or cdc.gov to learn more about this vaccine.

HPV - This vaccine is for girls 11 to 12 years of age, but it may be given as early as 9 years of age. Girls and women aged 13 through 26 who have not had the vaccine, should talk to their doctor about a catch-up vaccine. HPV may be given to males aged 9 through 26 years to lessen their chance of getting genital warts.

Meningococcal vaccine - Two doses of this vaccine are given. The first dose at 11 or 12 years of age and the next dose at 16.

Measles, mumps, rubella (MMR) and varicella - If you are 19 years of age or older and you have no proof you had these vaccines and you have never had these illnesses, then you should get these vaccines.

* This guide is for people with average risk. Some people may be at higher risk for health issues due to their family health history, their race or ethnicity, or other reasons. Talk to your doctor if you have concerns about your health.

Sources

American Academy of Family Physicians	Advisory Committee on Immunization Practices	American Cancer Society	Centers for Disease Control and Prevention
American Academy of Pediatrics	American College of Obstetrics and Gynecology	Adult Treatment Panel III/National Cholesterol Education Program	U.S. Preventive Services Task Force

Well-person exam: The doctor may talk with you about health and wellness issues. These include healthy eating, exercise, family planning for ages 19-39, how to prevent injuries, misuse of drugs and alcohol, how to stop using tobacco, secondhand smoke, sexual behavior, dental health and mental health. At this visit, you may get vaccines and these screenings:

	Age (in years)
Screenings	19	20-29	30-39	40-49	50-64	65+
Blood Pressure	each year or as your doctor suggests
Height, Weight	each year or as your doctor suggests
Body mass index BMI	each year or as your doctor suggests
Cholesterol		every 5 years starting at age 20 with more screenings as your doctor suggests
Colorectal cancer					at age 50, your doctor may suggest one of these test options: Fecal occult blood test (FOBT) each year Flexible sigmoidoscopy every 5 years Both #1 and #2 Double-contrast barium enema every 5 years Colonoscopy every 10 years CT colonography may take the place of a colonoscopy in some cases
Prostate cancer					if you are 50 or older, discuss with your doctor the risks and benefits of the prostate cancer tests
Abdominal aortic aneurysm						one time for ages 65-75 for those who have ever smoked
Hearing						when doctor suggests

	Age (in years)
Suggested Vaccines*	19-49	50-64	65+
Tetanus, diphtheria, pertussis (Td/Tdap)	✓ Td booster every 10 years
Influenza (Flu)	✓ each year
Pneumococcal polysaccharide (PPSV)****	✓ suggested for smokers and asthmatics****		✓ 1 lifetime dose
Zoster		✓ 1 single dose for ages 60+

✓ Shows when vaccines are suggested

Tdap (adults)-Adults should have one dose of Tdap.
 
Flu - Refer to flu.gov or cdc.gov to learn more about this vaccine.

* This guide is for people with average risk. Some people may be at higher risk for health issues due to their family health history, their race or ethnicity, or other reasons. Talk to your doctor if you have concerns about your health.

**** Pneumococcal polysaccharide (PPSV) for smokers and asthmatics – give 1 dose if never got the vaccine or if don't know vaccine history

Sources

American Academy of Family Physicians	Advisory Committee on Immunization Practices	American Cancer Society	Centers for Disease Control and Prevention
American Academy of Pediatrics	American College of Obstetrics and Gynecology	Adult Treatment Panel III/National Cholesterol Education Program	U.S. Preventive Services Task Force

Well-person exam: The doctor may talk with you about health and wellness issues. These include healthy eating, exercise, family planning for ages 19-39 and folic acid for women who are of the age to get pregnant, how to prevent injuries, misuse of drugs and alcohol, how to stop using tobacco, secondhand smoke, sexual behavior, dental health and mental health. At this visit, you may get vaccines and these screenings:

	Age (in years)
Screenings	19	20-29	30-39	40-49	50-64	65 +
Blood pressure	each year or as your doctor suggests
Height, weight	each year or as your doctor suggests
Body mass index BMI	each year or as your doctor suggests
Cholesterol		every 5 years starting at age 20 with more screenings as your doctor suggests
Colorectal cancer					at age 50, your doctor may suggest one of these test options: Fecal occult blood test (FOBT) each year Flexible sigmoidoscopy every 5 years Both #1 and #2 Double-contrast barium enema every 5 years Colonoscopy every 10 years CT colonography may take the place of a colonoscopy in some cases
Hearing						when the doctor suggests
Breast cancer: self-exam	each month from age 19 to 65+
Breast cancer: doctor exam	every 2 to 3 years			each year from age 40 to 65+
Breast cancer: mammogram				each year from age 40 to 65+
Cervical cancer: ages 19-39	each year starting within 3 years of sexual activity or age 21 (whichever comes first)
Cervical cancer: ages 30-69			Every 2 to 3 years for women with 3 normal Pap tests in a row
Cervical cancer: ages 70+						with 3 or more normal Pap tests in a row and no abnormal Pap tests in the last 10 years, women may stop having this screening.
Chlamydia	sexually active women ages 25 and younger
Osteoporosis					the test to check how dense your bones are should start no later than age 65; women at menopause should talk to their doctor about osteoporosis and have the test when at risk

	Age (in years)
Suggested Vaccines*	19-49	50-64	65+
Tetanus, diphtheria, pertussis (Td/Tdap)	✓ Td booster every 10 years
Influenza (Flu)	✓ each year
Pneumococcal polysaccharide (PPSV)****	✓ suggested for smokers and asthmatics****		✓ 1 lifetime dose
Zoster		✓ 1 single dose for ages 60+

✓ Shows when vaccines are suggested

Tdap (adults)-Adults should have one dose of Tdap.

Flu - Refer to flu.gov or cdc.gov to learn more about this vaccine.

* This guide is for people with average risk. Some people may be at higher risk for health issues due to their family health history, their race or ethnicity, or other reasons. Talk to your doctor if you have concerns about your health.

**** Pneumococcal polysaccharide (PPSV) for smokers and asthmatics – give 1 dose if never got the vaccine or if don't know vaccine history

Sources

American Academy of Family Physicians	Advisory Committee on Immunization Practices	American Cancer Society	Centers for Disease Control and Prevention
American Academy of Pediatrics	American College of Obstetrics and Gynecology	Adult Treatment Panel III/National Cholesterol Education Program	U.S. Preventive Services Task Force

Pregnant women should see their doctor or OB/GYN in their first three months for a first visit and to set up a prenatal care plan. At this visit your doctor will check your health and the health of your baby. Based on your past health, your doctor may want you to have these tests, screenings or vaccines:.

Hematocrit/hemoglobin (blood count)
Syphilis
HIV
Rubella immunity - to find out which women need the rubella vaccine after giving birth
Rh(D) blood type and antibody testing - if Rh(D) negative, repeat test at 26 to 28 weeks
Hepatitis B
Urinalysis - when your doctor wants it

The doctor may talk to you about what to eat and how to be active when pregnant as well as staying away from tobacco, drugs, alcohol and other substances.

Other tests and screenings:
Some tests given alone or with other tests can be used to check the baby for health concerns. These tests are done at certain times while you are pregnant. The best test to use and the best time to do it depends on many things. These include your age as well as your medical and family history. Talk to your doctor about what these tests can tell you about your baby, the risks of the tests and which tests may be best for you.

Special blood tests
Ultrasound tests including special tests (used with blood tests during the first three months for chromosomal abnormality risk) and routine two-dimensional tests to check on the baby
Amniocentesis
Chorionic villus sampling

Vaccines::
If you are pregnant in flu season (October to March) your doctor may want you to have the inactivated flu vaccine. You may need the tetanus, diphtheria, pertussis (Tdap) vaccine if you have not had it before. While other vaccines may be given in special cases, it is best to get the vaccines you need before you get pregnant. Women should always check with their doctor about their own needs.

You should NOT get these vaccines while you are pregnant:

Measles, mumps, rubella (MMR)
Varicella

Sources

American Academy of Family Physicians	Advisory Committee on Immunization Practices	American Cancer Society	Centers for Disease Control and Prevention
American Academy of Pediatrics	American College of Obstetrics and Gynecology	Adult Treatment Panel III/National Cholesterol Education Program	U.S. Preventive Services Task Force