Guidelines for Adults

Please note that the following services may not be covered benefits under your plan. Call the Member Services number on your ID card to verify coverage.

Screenings for Men and Women Ages 21 and Older

• Medical history and physical exam: at the discretion of the doctor and patient

• Height: at least once with follow-up as necessary

• Weight: screen all adults for obesity; body mass index (BMI) when needed

• Blood pressure: every 1 to 2 years or at each visit

• Cholesterol: every 5 years for men and women ages 20 and older. If family history is unknown and/or you have other risk factors, such as smoking, diabetes,  and high blood pressure,   measure HDL, LDL, and total cholesterol levels.

• Diabetes:   for patients with any of these risk factors: obesity (BMI ≥25), family history, diabetes during pregnancy, delivery of baby more than 9 lbs., high blood pressure, high cholesterol, abnormal blood sugar, history of vascular disease, and those of African-American, Hispanic-American, Native-American, Asian-American or Pacific-Islander ancestry

• Colorectal cancer: begin at age 50 for men and women with average risk; colonoscopy every 10 years OR flexible sigmoidoscopy every five years OR yearly fecal occult blood test PLUS flexible sigmoidoscopy every five years OR barium enema every five years OR yearly fecal occult blood test

• Depression: screen at first visit regularly thereafter

• Screening for high-risk factors and counseling: depending on the patient’s age, one or more of the following topics should be discussed or screened for during physical exams: substance abuse, tobacco, alcohol and drug use (avoidance), diet and exercise, injury prevention, dental health, sexual behavior, tuberculosis (TB), hepatitis A, B and C, chlamydia, gonorrhea, HIV, use of alternative medicines and therapies, depression and domestic violence

• Osteoporosis: begin at age 50 for men and women at increased risk for fractures from osteoporosis

Screenings for Men Only

• Prostate cancer: annual digital rectal exam beginning at age 40 for men who are African-American or have a family history of prostate cancer; begin at age 50 for men at average risk with a life expectancy more than 10 years

• Aortic abdominal aneurysm: one ultrasonography for men ages 65 to 75 who are current or former smokers

Screenings for Women Only

• Breast cancer: beginning at age 40, mammogram every one to two years, with or without clinical breast exam

• Cervical cancer: ·Pap smear and pelvic exam by age 21 or within 3 years of first sexual activity, whichever comes first; repeat yearly. If 3 consecutive exams are normal, Pap test every 1-3 years and annual pelvic exam.Combination Pap test and HPV DNA test for women ages 30 and older at the discretion of the practitioner and patient; if results are negative, repeat in 3 years; annual pelvic exam

• Chlamydia: for sexually active women ages 25 and younger; older than age 25 at doctor’s discretion

• Menopause counseling:   women who are of menopausal age should be counseled regarding menopause, risks and benefits of estrogen replacement, treatment and lifestyle modifications for women  of menopausal age

• Osteoporosis: begin at age 65 for women at average risk