PREVENTIVE PROGRAM

PEDIATRIC

ROUTINE HISTORY AND PHYSICAL EXAMINATIONS

Age 0-1 mo: One exam Age 6-8 mos.: One exam Age 15-17 mos.: One exam
Age 2-3 mos., One exam Age 9-11 mos.: One exam Age 18-24 mos.: One exam
Age 4-5 mos., One exam Age 12-14 mos.: One exam Age 2-3 yrs.: One exam every year

Note: When a range is given (E.G., 2-3 months),the dash Age 4-17 yrs.: One exam every year
indicates that coverage is available for one service from two months through three months of age)


ROUTINE TESTING, SCREENING AND VACCINES
Urinalysis
Age 0-17
One test every year


Lead Screening
Age 9-12 mos.

Age 24 mos.
One screening

One screening
Tine Test
Age 0-17
One test every year
Hemoglobin/Hematocrit
Age 0-12 mos.

Age 1-4 yrs.

Age 5-12 yrs.

Age 14-17 yrs.
One test

One test

One test

One test
Rubella Titer Test
Age 11-17 mos.
One test
Pediatric Immunizations
From Age 0-17

Hepatitis B

Polio

Diphtheria, Tetanus, Pertussis

Measles, Mumps, Rubella

H. Influenza Type B

Varicella (Chicken Pox)



It is important that you discuss the vaccination schedules with your doctor, and that you keep good records of the vaccination dates.

Remember, the only screenings tests, or vaccines covered under the adult and/or pediatric preventive programs are those that are listed above. If you are uncertain as to what is routine and what is not, please call the Fund office at 800-228-7484 or 609-662-8383. There may be minor variances in the individual plans. Please call the Fund Office with questions.

PREVENTIVE PROGRAM

ADULT

If you're looking for a jump start to feeling better, a routine exam may prove to be a healthy first step. When you are eligible to receive routine care from an in-network provider there is no charge to you or your eligible family members. Frequently, a doctor will want to order tests as a part of the routine exam. Remember, the only screenings, tests, or vaccines covered under the adult and/or pediatric preventive programs are those that are listed below. If you are uncertain as to what is not, please call the Fund office at 800-228-7484 or 609-662-8383.

ROUTINE HISTORY AND PHYSICAL EXAMINATIONS

Age 18 - 21: One exam every year
Age 22 - 39: One exam ever 3 years
Age 40 - : One exam every year

ROUTINE TESTING, SCREENING AND VACCINES
Complete Blood Count (CBC)
Age 18 - 21

Age 22 - 39

Age 40+
One test every year

One test every 3 year

One test every year
Blood Cholesterol Test
Age 18 - 39

Age 40+
One test every 4 years

One test every year
Thyroid Screening
Age 18 - 65+
One screening every year
Prostate Specific Antigen (PSA)
Age 50+
One test every year
Urinalysis
Age 18 - 65+
One urinalysis every year
Fecal Occult Blood Test
Age 50+
One test every year
Flexible Sigmoidoscopy
Age 50 - 65+
One exam every 3 years
Adult Tetanus Toxoid
Age 18+
One shot every 10 years
Rubella Titer Test
Age 18 - 49
One test
Influenza Vaccine
Age 18+
One vaccine every year
Pneumococcal Vaccine
Age 64+
One vaccine every 5 years
Adult Immunizations
From Age 18 to 21

Hepatitis B

Polio

Diphtheria, Tetanus, Pertussis

Measles, Mumps, Rubella

H. Influenza Type B

Varicella (Chicken Pox)



There may be minor variance in the individual plans; please call the Fund Office with questions.