Skip To Main Content

Español

Main Content

Preventive Health Guidelines

As of May 2016

 

What is your plan for better health?

Make this year your best year for wellness. Your health plan may help pay for tests to find disease early and routine wellness exams to help you and your family stay well. 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, see your certificate of coverage or call the customer care number on your ID card.
 
You also can check anthem.com to learn about health topics from child care to zinc.
 
This guide is just for your learning it is not meant to take the place of medical care.
 
Use this guide to know when to set up visits with your doctor for you and your children. Ask your doctor which exams, tests and vaccines are right for you, when you should get them and how often.
 
How you get certain diseases is not talked about in this guide.
 
Please see your plan handbook to check on your plan benefits.
 


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. You might talk to the doctor if you are a fi rst-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, dental exams and care, overall health, diet, physical activity and development. At these exams, your baby may get vaccines and the screenings listed below or others, such as tuberculin and sickle cell anemia, if needed.
 
 Age (in months)
Screeningsbirth1246912151824
Weight, length and head circumference(the length around the head)at each visit
Newborn metabolic, sickle cell and thyroid screeningBirth to 2 months       
Development and behaviorat each visit
Hearingas a newborn and when your doctor suggests
Oral/dental healthat 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
Autism        at 18at 24
 
 Age (in months)

Suggested Vaccines*
For additional information regarding vaccinations refer to http://www.cdc.gov/vaccines

birth1-22466-1812-1515-1819-23
Hepatitis BCheckedChecked   Checked   
Rotavirus (RV)  Checked 2-dose or 3-dose series    
Diphtheria, tetanus, pertussis (DTaP)  CheckedCheckedChecked  Checked 
Tetanus, diphtheria, pertussis (Td/Tdap)         
Haemophilus influenza type b (Hib)  Checked 3- or 4-dose series - 1st dose at 2 months - last dose at 12-15 months.  
Pneumococcal conjugate (PCV)  CheckedCheckedChecked Checked  
Inactivated polio virus (IPV)  CheckedChecked Checked   
Influenza (Flu)    Checked suggested each year from 6 months to 65+years of age
Measles, mumps, rubella (MMR)      Checked  
Varicella (chicken pox)      Checked  
Hepatitis A      Checked 2-dose series
 
Checked Shows when vaccines are suggested
 
Hepatitis B -You may get an extra dose (four-dose series) at 4 months if the combination vaccine is used after the birth dose. If you are 18 years or older, you should get a screening if you are high risk for infection.
Rotavirus (RV) - Get two-dose or three-dose series (depends on brand of vaccine used).
Haemophilus influenza type b (Hib) - Get three-dose or four-dose series (depends on brand of vaccine used).
Pneumococcal conjugate (PCV) - Children aged 14 months through 59 months who have received an age-appropriate series of 7-valent PCV (PCV7), administer a single supplemental dose of 13-valent PCV (PCV13).
Influenza (Flu) - Refer to flu.gov or cdc.gov to learn more about this vaccine. (Children 6 months to 8 years of age having the vaccine for the first time should have two doses separated by 4 weeks)
Measles, mumps, rubella (MMR) and varicella (chicken pox) - All adults born after 1957 should have documentation of one or more doses of MMR vaccine unless they have a medical contraindication to the vaccine, or laboratory evidence of immunity to each of the three diseases.
 
*This guide is for people enrolled in the Anthem plan. Some people may be at higher risk for health issues due to their family history, their race or ethnicity, or other reasons. Talk to your doctor if you have concerns about your health.
**Get fluoride varnish on the teeth when your doctor suggests. Your doctor may also give you a Fluoride prescription, depending on your drinking water.
*** Height and weight is used to find BMI. BMI is used to see if a person has the right weight for height, or is under or over weight for height.
 
 
Sources
 

Well-child exam — ages 2 ½ to 10 years*:

You may get advice about how to keep your child safe, how to prevent injuries, counseling to reduce the risks of getting skin cancer, good health, diet, physical activity and development. Annual dental referrals starting at age 3 or earlier, if needed. At these well-child exams, your child may get vaccines and the screenings listed below or others, such as tuberculin and urine, if needed.
 
 Age (in years)
Screenings2 1/2345678910
Height, weight, body mass index (BMI)**Each year
Development and behaviorAt each visit
VisionEach year
HearingEach year
Oral/dental health Fluoride**Each year
Blood pressure each year starting at 3 years
 
 
 Age (in years)
Suggested Vaccines*2 1/234567-10
Diphtheria, tetanus, pertussis (DTaP)  Checked 
Inactivated polio virus (IPV)  Checked 
Influenza (Flu)Checked Suggested each year from 6 months to 65+ years of age
Measles, mumps, rubella (MMR)  Checked 
Varicella (chicken pox)  Checked 
Checked Shows when vaccines are suggested
 

Well-child exam — ages 11 to 18 years*:

The doctor may talk to you about health and wellness issues. These include diet, exercise, healthy weight, sexual health, sexually transmitted infections, how to prevent injuries, alcohol and drugs, counseling to reduce the risks of getting skin cancer, avoiding tobacco, secondhand smoke, dental health and mental health. At these exams, your child may get vaccines and the screenings listed below or others, such as tuberculin and urine, if needed.
 
 Age (in years)
Screenings1112131415161718
Height, weight, body mass index (BMI)***each year
Development and behavioreach year
Blood pressureeach year
Visioneach year
Hearingeach year
Oral/dental healtheach year
ChlamydiaFor sexually active women aged 24 and younger
 
* This guide is for people enrolled in the Anthem plan. Some people may be at higher risk for health issues due to their family history, their race or ethnicity, or other reasons. Talk to your doctor if you have concerns about your health.
** Get fluoride varnish on the teeth when your doctor suggests. Your doctor may also give you a f l luoride prescription, depending on your drinking water.
*** Height and weight is used to find BMI. BMI is used to see if a person has the right weight for height, or is under or over weight for height.
 
 Age (in years)

Suggested Vaccines*
For additional information regarding vaccinations refer to http://www.cdc.gov/vaccines

11-1213-18
Tetanus, diphtheria, pertussis (Td/Tdap)Checked Tdap 
Influenza (Flu)Checked Suggested each year from 6 months to 65+ years of age
Human papillomavirus (HPV)Checked Three-dose (series) 
MeningococcalCheckedChecked At age 16
Checked 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.
Influenza (Flu) - Refer to flu.gov or cdc.gov to learn more about this vaccine.(Children 6 months to 8 years of age having the vaccine for the fi rst time should have two doses separated by four weeks.)
Human papillomavirus (HPV) - This vaccine is for girls(2vHPV, 4vHPV4 or 9vHPV ) and boys (4HPV4 or 9vHPV) 11 to 12 years of age, but it may be given as early as 9 years of age. This vaccine can be given up to age 26. The second dose is given one to two months after the first dose. The third dose is given 24 weeks after the first dose and 16 weeks after the second dose.
Meningococcal - Two doses of this vaccine are given.The fi rst dose at 11 or 12 years of age and the next dose at 16. Teens and young adults (16 through 23 year olds) may also be vaccinated with a serogroup B meningococcal vaccine (2 or 3 doses depending on brand), preferably at 16 through 18 years old.
 
* This guide is for people enrolled in the Anthem plan. Some people may be at higher risk for health issues due to their family history, their race or ethnicity, or other reasons. Talk to your doctor if you have concerns about your health.
 
    
Sources   
    

Well-person exam —

The doctor may talk with you about health and wellness issues. These include diet, exercise, family planning, how to prevent injuries, misuse of drugs and alcohol, how to stop using tobacco, secondhand smoke, sexual behavior and screening for sexually transmitted infections including HIV and HBV (if high risk) counseling to reduce the risks of getting skin cancer, special risks you might have for cancer (such as family history) and steps you can take to manage any such risks, dental health and mental health, including screening for depression. At this visit, you may get vaccines and these screenings:
 
 Age (in years)
Screenings1920253035404550556065 and older
Height, WeightEach year or as your doctor suggests
Body mass index(BMI)Each year or as your doctor suggests
Blood pressureEach year or as your doctor suggests; high measurements should be confi rmed in the home setting
Cholesterol    Every 5 years starting at age 35, with more screenings as your doctor suggests or for men ages 20-35, if at increased risk for coronary heart disease
Colorectal cancer       

At age 50, your doctor may suggest one of these test options:

  1. Fecal occult blood test (FOBT) each year
  2. Flexible sigmoidoscopy every fi ve years
  3. Both #1 and #2
  4. Double-contrast barium enema every five years
  5. Colonoscopy every 10 years
  6. CT colonography may take the place of a colonoscopy in some cases
Glucose screening for Type 2 Diabetes     As your doctor suggests, from 40 to 70, if you are overweight or obese. Individuals with high glucose should talk to their health care provider about intensive counseling interventions to promote a healthful diet and physical activity.
Prostate cancer       If you are 50 or older, discuss with your doctor the risks and benefi ts of the prostate cancer tests.
Abdominal aortic aneurysm          One time for ages 65-75 if you have ever smoked
Hepatitis C       Screen once if born 1945-1965
 
 Age (in years)

Suggested Vaccines*
For additional information regarding vaccinations refer to http://www.cdc.gov/vaccines

19-6060-6465+
Tetanus, diphtheria, pertussis (Td/Tdap)Checked Td booster every 10 years
Influenza (Flu)Checked Suggested each year from 6 months to 65+ years of age
Pneumococcal 13-valent conjugate(PCV13)  Checked
Pneumococcal polysaccharide (PPSV 23)Checked Suggested for certain individuals at riskChecked
Zoster One single dose for ages 60+
 
Checked Shows when vaccines are suggested
 
Tdap (adults)- If you are 19 years of age or older and have not gotten a dose of Tdap before, you should get a single dose.
Influenza (Flu) - Refer to flu.gov or cdc.gov to learn more about this vaccine. (Children 6 months to 8 years of age having the vaccine for the fi rst time should have two doses separated by four weeks.)
Pneumococcal 13-valent conjugate (PCV13) - If you have not gotten PPSV23, you should get PCV13 first followed by PPSV23 six to 12 months later. If you have gotten PPSV23, get PCV13 12 months or more later. If you are not sure of your vaccine history, you should get PCV13 before PPSV23.
Pneumococcal polysaccharide(PPSV23) - Adults 65 years and older and certain adults younger than 65 who are considered at risk are recommended to receive both a PCV13 and PPSV23. Ask your doctor about the dosing recommendation that is right for you.
 

Well-person exam:

The doctor may talk with you about health and wellness issues. These include diet, exercise, family planning and folic acid for women who are of the age to get pregnant, sexual behavior and screening for sexually transmitted infections including HIV and HBV if high risk as well as intimate partner violence. It also includes how to prevent injuries, counseling to reduce the risks of getting skin cancer, special risks you might have for cancer (such as family history) and steps you can take to manage any such risks, misuse of drugs and alcohol, how to stop using tobacco, secondhand smoke, dental health and mental health, including screening for depression. At this visit, you may get vaccines and these screenings:
 
 Age (in years)
Screenings19-2121-293035404550556065 and older
Height, weightEach year or as your doctor suggests
Body mass index (BMI)Each year or as your doctor suggests
Blood pressureEach year or as your doctor suggests; high measurements should be confirmed in the home setting
Breast cancer: doctor examEvery one to three yearsEach year from age 40 to 65+
Breast cancer: mammogram    Each year from age 40 to 65+**
Cervical cancer: ages 21-29 Every three years        
Cervical cancer: ages 30-65  Should have a Pap test plus an HPV test (called "co-testing") every five years. This is the preferred approach, but it is alright to have a Pap test alone every three years.
Cervical cancer: ages 65+         Stop screening at age 65 if last three Pap tests or last two Co-tests (Pap plus HPV) within the previous 10 years were normal. If there is a history of an abnormal Pap test within the past 20 years, discuss continued screening with your doctor.
Colorectal cancer      

At age 50, your doctor may suggest one of these test options:

  1. Fecal occult blood test (FOBT) each year
  2. Flexible sigmoidoscopy every five years
  3. Both #1 and #2
  4. Double-contrast barium enema every five years
  5. Colonoscopy every 10 years
  6. CT colonography may take the place of a colonoscopy in some cases
ChlamydiaSexually active women ages 24 and younger        
Cholesterol     Every 5 years starting at age 45, with more screenings as your doctor suggests or for women ages 20-45, if at increased risk for coronary heart disease 
Contraceptive methods and counseling***          
Glucose screening for Type 2 Diabetes    As your doctor suggests, from 40 to 70, if you are overweight or obese. Individuals with high glucose should talk to their health care provider about intensive counseling interventions to promote a healthful diet and physical activity.
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.
Hepatitis C      Screen once if born between 1945-1965.
 
 Age (in years)

Suggested Vaccines*
For additional information regarding vaccinations refer to http://www.cdc.gov/vaccines

19-6060-6465+
Tetanus, diphtheria, pertussis (Td/Tdap)Checked Td booster every 10 years
Influenza (Flu)Checked Suggested each year from 6 months to 65+ years of age
Pneumococcal 13-valent conjugate(PCV13)  Checked
Pneumococcal polysaccharide (PPSV 23)Checked Suggested for certain individuals at riskChecked
Zoster One single dose for ages 60+
 
Checked Shows when vaccines are suggested
 
Tdap (adults)- If you are 19 years of age or older and have not gotten a dose of Tdap before, you should get a single dose.
Influenza (Flu) - Refer to flu.gov or cdc.gov to learn more about this vaccine. (Children 6 months to 8 years of age having the vaccine for the fi rst time should have two doses separated by four weeks.)
Pneumococcal 13-valent conjugate (PCV13) - If you have not gotten PPSV23, you should get PCV13 first followed by PPSV23 six to 12 months later. If you have gotten PPSV23, get PCV13 12 months or more later. If you are not sure of your vaccine history, you should get PCV13 before PPSV23.
Pneumococcal polysaccharide(PPSV23) - Adults 65 years and older and certain adults younger than 65 who are considered at risk are recommended to receive both a PCV13 and PPSV23. Ask your doctor about the dosing recommendation that is right for you.
 
Pregnant women should see their doctor or OB/GYN in their first three months of pregnancy 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:
  • Depression - screening during or after pregnancy
  • Diabetes during pregnancy
  • Hematocrit/hemoglobin (blood count)
  • Hepatitis B
  • 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
  • Syphilis
  • 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. You also may discuss breast-feeding support, supplies and counseling.
 
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:
 
  • Amniocentesis
  • Chorionic villus sampling
  • Special blood tests
  • Ultrasound tests including special tests (used with blood tests during the fi rst three months for chromosomal abnormality risk) and routine two-dimensional tests to check on the baby
 
Medications:
If you are at high risk for a condition called preeclampsia, your doctor may recommend the use of low-dose aspirin, as preventive medication.
 
Vaccines:
If you are pregnant in fl u season (October to March), your doctor may want you to have the inactivated flu vaccine. Pregnant adolescents and adults should be vaccinated with Tdap vaccine with each pregnancy. 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
 
* This guide is for people enrolled in the Anthem plan. Some people may be at higher risk for health issues due to their family history, their race or ethnicity, or other reasons. Talk to your doctor if you have concerns about your health.
 
 

Member Log In


Useful Tools

  • If it’s not an emergency (and you can’t get to your regular doctor) - there are other options for fast, more affordable care.

    Link to more


  • Prescription Benefits

  • *Required Field:
    *
    Can't remember your claim number? View Claims