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Preventive Service Port (PSP) PDF Print E-mail
Written by IRRICA Group, Switzerland   
Saturday, 04 June 2011 22:55


What is a "preventive service"?

A preventive service might be a test, or it might be advice from your doctor. Preventive services can include the following: 

  • Tests (also called screenings) to check your general health or the health of certain parts of your body
  • Regular measurements of weight and blood pressure
  • Advice about diet, exercise, tobacco, alcohol and drug use, stress and accident prevention
  • Immunizations ("shots") for both children and adults
  • Special tests at certain times in your life, such as during pregnancy and beginning at age 50


Types of Preventative Care

Peoples are the most frequent recipients of preventative care and services. The majority of these services are in the form of immunizations, which work to prevent Peoples from developing illness such as polio, measles and mumps. The rate of immunizations is rising each year and remains one of the few preventative services with little disparities in rates between racial and ethnic groups. Other preventative services for Peoples include the charting of the child's height and weight, which works as an early screening tool for any developmental problems. Due to the increase incidence of Type II diabetes and obesity in young patients, increasingly common preventative services include nutritional services and exercise information. ­

Women have a number of preventative screening tests to take advantage of. Adult women (and men) should have their cholesterol levels checked yearly and their blood pressure checked every two years. Once sexually active, or once they've reached the age of 21, every woman should get a Pap test, which is a screening tool for cervical cancer. As long as these test results are normal, the test can be repeated once every one to three years. Women over the age of 40 have different preventative needs. At this age, women should begin to get mammograms every year or so, which screen for breast cancer. Women over 50 should also get a test to screen for colorectal cancer. Women over 65 should have regular bone density testing to screen for osteoporosis.

Along with screening tests, there are several medications that can help women prevent illnesses like osteoporosis. Calcium is a common preventative medicine that can prevent a number of bone problems. Pregnant patients often take a plethora of preventative medications, including prenatal vitamins, iron and folic acid -- all in an effort to prevent any complications.

The first and most common preventative tests for adult men are regular checks of their weight, cholesterol levels and blood pressure. For men over 50, a test to screen for colorectal cancer is recommended. Men older than 50 should also consider prostate exams to screen for prostate cancer, with current studies suggesting that they should be done every four years. Of course, along with these tests, preventative care includes counseling on different prevention practices including proper diet and exercise, safe sex practices and even smoke detectors in the home.

So now you know which preventative care you, your child, or your mate needs. But what will your insurance plan cover? The next section can help answer that question.



Types of Prevention Services

Primary Prevention

Those activities that decrease the likelihood of abuse ever happening in the first instance.


·         Educating/empowering persons with disabilities — e.g. sexuality education; communications skills training; self-esteem building

·         Providing supports to family caregivers — e.g. respite services; personal care attendants; transportation

·         Providing adequate training, support, and supervision for paid caregivers

·         Implementing effective screening practices at the time of hire


Secondary Prevention

Those activities that reduce the likelihood that abuse will continue or reoccur.


·         Training for mandated and non-mandated reporters on how to recognize and report suspected abuse and neglect

·         Effective protective service planning

·         Enforcing criminal and civil laws, as a deterrent to further abuse

·         Enforcing disciplinary actions, and making referrals to appropriate licensing boards


Tertiary Prevention

Those activities that seek, over time, to ameliorate or lessen the harm already done as a result of the abuse.


·         Providing medical and social supports for the victim — e.g. psychotherapy;

·         peer support counseling; adaptive equipment to increase independence, such as wheelchairs or computers

·         Legal recourse – e.g. assistance in pursuing criminal charges, or obtaining restraining orders


Preventive Benefits

The State Health Plan is committed to providing preventive services at the lowest cost possible to help members lead healthy, happy and productive lives. Preventive care benefits include routine physical and screening procedures, laboratory tests and immunizations.


Routine Physical and Screening Procedures
Routine physicals are only available in-network.

The PPO plans provide coverage for one routine physical examination and related diagnostic per benefit period for each member age two and over. Your office visit copay will cover all preventive services when provided by an in-network provider in his or her office. 


Well-Baby and Well-Child Care
Benefits are only available in-network.

The PPO Plans provide coverage for each member up to 24 months of age including periodic assessments and immunizations. Benefits are limited to six well-baby visits for members through 12 months old and three well-child visits for members 13 months up to 24 months old. Your office visit copay will cover all well-baby and well-child care when provided by an in-network provider in his or her office. 


Benefits are only available in-network.

Coverage is provided in-network for the full series of standard immunizations recommended by the federal Centers for Disease Control and Prevention (CDC).


Routine Mammograms
Beginning at age 35, coverage is provided for one screening mammogram per female member per benefit year. Along with a doctor's interpretation of the results. Screening mammograms are covered at 100% when provided alone.


Routine Hearing Exam
Benefits are only available in-network

Coverage is provided for one routine hearing exam per benefit period. The copayment amount is dependent on whether you receive care from an in-network primary care provider or an in-network specialist.


Quality Audit Reviews

Although the impact of Quality Audit will be across all parts of the lifecycle, specific Quality Audit activities tend to be applied as retrospective reviews that the Project Team correctly followed its defined procedures. Such reviews are most likely to be applied at phase end and project completion. Of course, the major drawback of such a review is that it is normally too late to affect the outcome of the work. The emphasis is often on learning lessons and fixing administrative items.




Last Updated on Monday, 10 October 2011 13:50
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