Health & Security Plan > SPD > Physical Examinations – 100%

Summary Plan Description

Physical Examinations—100%

This Benefit Is For Participants, Spouses and Domestic Partners

Benefits are provided for preventive health services when performed by a physician. These services are not subject to the annual deductible, office visit copayment(s) or annual coinsurance. All services are subject to the Preventive Health Benefit Schedule.

These benefits are also available to adult children ages 19 through 25. Services are not subject to the annual deductible but are subject to the office visit copayments and annual coinsurance.

Key Point

Your preventive examination is an important opportunity to periodically review health and behavioral risk factors, and to obtain information and advice on how to achieve and maintain optimum health through active participation in preventive care.

Preventive Health Benefit Schedule
For All Adults (Ages 19 and Older)
Type of Service Frequency
Health Evaluation Every 3 years for children ages 19-25; annually for participants, spouses and domestic partners.
Blood Glucose Test Every 3 years for children ages 19-25; annually for participants, spouses and domestic partners.
Total Lipid Profile Test Every 3 years for children ages 19-25; annually for participants, spouses and domestic partners.
Fecal Occult Blood Test Annually beginning at age 50.
General Health and Basic Metabolic Panel Every 3 years for children ages 19-25; annually for participants, spouses and domestic partners.
Digital Rectal Examination Annually beginning at age 40.
Colorectal Cancer Screening Beginning at age 50, annual fecal occult blood test plus one of the following screening options:
  • Flexible sigmoidoscopy every 5 years; or
  • Colonoscopy every 5 years; or
  • Double contrast barium enema every 5 years.
Influenza Vaccine Annually.
For Women
Gynecological Examination Annually beginning at age 18 or earlier if sexually active.
Mammography Baseline mammogram test once between ages 35 and 40. Annually beginning at age 40.
Pap Smear Test Annually beginning at age 18 or earlier if sexually active.
Chlamydia Screening Annually beginning at age 18 or earlier if sexually active (usually done during a routine gynecological exam).
Clinical Breast Examination Annually beginning at age 18.
Human Papillomavirus Vaccine (HPV) This three-dose series is given over a six-month period, for young adolescents and women between ages 9 and 26.
Thyroid Test (TSH) Every 5 years beginning at age 35.
Osteoporosis Screening (bone mass measurement test) Once every 2 years for post menopausal women.
For Men
Clinical Testicular Examination Annually and recommended during well child visit and health examination.
Prostate-Specific Antigen (PSA) Test Annually beginning at age 50 or earlier if determined to be at high risk.
Abdominal Aortic Aneurysm Screening Ultrasound Once in a lifetime for men ages 65 through 75 who smoke or previously smoked.
Osteoporosis Screening (bone mass measurement test) Once every 2 years for men age 70 and older.
Additional Tests and Immunizations for Men and Women
Tetanus Diphtheria (Td) or Tetanus, Diphtheria and Acellular Pertussis (Tdap) Booster Shot Every 10 years after age 18.
Pneumococcal Polysaccharide Vaccine (PPSV) Once on or after reaching age 65. Starting at younger age for certain risk factors.
Shingles Vaccine (Herpes Zoster) A single dose for adults age 60 and older.
Hearing Test Once on or after reaching age 65.
Visual Acuity/Glaucoma Tests Every 3 years beginning at age 65.
Screening Urinalysis Annually.
Additional screening tests conducted for patients who are considered "at risk" are not part of the basic preventive benefit but may be covered under the normal plan benefit subject to the annual deductible and coinsurance. If you have a condition that requires yearly check-ups, the check-up will be covered, subject to the annual deductible, copayment(s) and coinsurance.