Routine visits or wellness visits are eligible for sharing.
Wellness Visits and Diagnostic tests are eligible for sharing as follows:
- One annual wellness visit for members 6 years and older per membership year is 100% sharable and is not subject to the PRA or co-share. Provider fees are not applied to this visit.
- Members under the age of 6 receive one annual visit. Additional visits will follow routine well child guidelines as dictated by the American Academy of Pediatrics. These additional visits are subjected to PRA and co-share. Well-child care is defined as recommended routine check-ups and associated lab work, excluding vaccinations and/or immunizations.
- Impact members are allotted a total of $150 lab credit which can be applied to the following labs:
- Complete Blood Count with Differential and Platelets
- Comprehensive Metabolic Panel
- Lipid Profile with Lipoprotein Particle Assessment
- Hemoglobin A1C
- Vitamin D-25 OH
- C-Reactive Protein
- Fecal Occult Blood Test
- Pap Smear
The following preventive screenings are subject to PRA and co-share. Provider fees will be applied as needed depending on the service rendered.
- Pap test—one every three years from age 21-65.
- Mammogram—one every year for ages 45-54, every two years starting at age 55.
- PSA test—one every year, starting at age 45.
- Colonoscopy—one every 10 years starting at age 45 or one every five years for members at high risk.
- As it pertains to eligible preventive care for both men and women, both the test and coordinated office visit will be eligible for sharing.
Infants and Children:
- Sharing for routine well-child care is eligible until the child reaches the age of six. Well-child care is defined as recommended routine check-ups and associated lab work, excluding vaccinations and/or immunizations.