By visiting each year with your Healthy You! Primary Care Network Provider to know your health numbers, you can establish goals to manage your health risks, feel better and live a healthier life. Healthy You! can help you identify potential health issues before they become serious problems.
Taking ownership of your health and living a healthy lifestyle today will allow you to be healthier in the future. You and your Primary Care Network Provider will not only be managing your health, but also your future healthcare costs.
There are some important numbers that you need to know to understand your risks for heart disease, stroke, diabetes, cancer and other diseases. These important numbers also known as biometrics, include your blood pressure, cholesterol, blood sugar (glucose), height and weight. Talk with your Primary Care Network Provider about these numbers – and make sure you know them at the end of your Healthy You! visit.
Blood Pressure
XBlood pressure is the force of blood against the inside walls of your arteries. It is recorded by systolic pressure, which is the pressure when blood is pumped out of the heart and into your arteries, and diastolic pressure, which is the pressure when your heart is resting. Normal blood pressure is classified with a number of less than 120 (systolic) over 80 (diastolic). High blood pressure, or hypertension, can increase your risk of heart disease, heart attack, and stroke. Like many health problems, blood pressure can often be managed through lifestyle changes such as eating healthy, exercising, and being tobacco-free.
Cholesterol
XCholesterol is a naturally occurring substance in the blood, but too much can increase your risk for heart disease. Your doctor will check different cholesterol levels in your blood to evaluate your risks. These types of cholesterol include "good" cholesterol (HDL), "bad" cholesterol (LDL) and triglycerides. You can have an impact on improving the "good" cholesterol and lowering the "bad" cholesterol with lifestyle changes.
Talk with your Primary Care
Network Provider about how to make these changes. Many times, it is possible to maintain a healthy cholesterol level through diet and exercise. If your provider does recommend a prescription drug, be sure to ask for a generic or lower-cost alternative."
Blood Sugar (Glucose)
XHigh blood sugar can lead to diabetes. Diabetes is a condition that results in the inability of the body to process carbohydrates and sugar (glucose). Diabetes is one of the fastest growing health problems and one of the leading causes of death in the United States.
Type 2 diabetes can be managed, or even prevented, by living a healthy lifestyle that includes a healthy diet and exercise.
BMI (Healthy Weight)
XBeing overweight can elevate your blood pressure, lead to Type 2 diabetes, and increase your risk for heart disease, cancer, arthritis and depression. Body Mass
Index (BMI) is the most common measure for defining if you are overweight or obese. If you are overweight or obese, talk with your provider about healthy ways to lose weight through changing your diet so you eat less (and eat healthy) and through exercise (by becoming more physically active).
How Healthy Are You?
Covered Services
Select the appropriate gender and age range to view the covered services for a Healthy You! Wellness visit. Make sure to speak to your Primary Care Network Provider about your covered services at your Healthy You! office visit. Also check out the list of questions to ask your Doctor below and think about any additional questions you may want to ask your Primary Care Network Provider at your visit.
Gender
Gender
Age Range
Preventive Medicine Evaluation or Re-evaluation
Preventive Medicine Evaluation or Re-evaluation
Preventive Medicine Evaluation or Re-evaluation
Hemoglobin, Hematocrit or CBC
Urinalysis
Immunizations
Blood Pressure
Glucose
Glucose
Lipid Profile
Lipid Profile
Breast Exam
Pap Smear
Pap Smear* Not available after 65 years of age
Pelvic Exam
Mammogram
Bone Density
Prostate Specific Antigen with Digital Rectal Exam
Stool for Occult Blood
Flexible Sigmoidoscopy Colonoscopy
XPreventive Medicine Evaluation or Re-evaluation
Once per calendar year
As part of preventive medicine evaluation or re-evaluation, preventive counseling as appropriate for age or stage of development and risk factors.
XPreventive Medicine Evaluation or Re-evaluation
For ages 8 days through 35 months: 10 Visits
As part of preventive medicine evaluation or re-evaluation, preventive counseling as appropriate for age or stage of development and risk factors.
XPreventive Medicine Evaluation or Re-evaluation
One wellness visit per calendar year
As part of preventive medicine evaluation or re-evaluation, preventive counseling as appropriate for age or stage of development and risk factors.
XHemoglobin, Hematocrit or CBC
CBC performed at 12 months of age and once between ages 11-18.
XUrinalysis Once per calendar year.
XBlood Pressure Once per calendar year.
XGlucose Once per calendar year.
Annual glucose screenings are available for at risk individuals age 3-39.
At risk individuals are defined as follows:
• Family history of diabetes (i.e., parents or siblings with diabetes)
• Obesity
• Blood pressure of 135/80 or greater
• Race/ethnicity (i.e., African-Americans, Hispanic-Americans, Native Americans,
Asian-Americans, or Pacific Islanders)
• Previously identified pre-diabetic or diagnosed diabetic
• Low HDL cholesterol or high triglycerides
• History of gestational diabetes
XGlucose Once per calendar year.
XLipid Profile Once per calendar year.
Lipid profile screenings are available to high-risk individuals between the ages of 2 and 17.
High-risk individuals should have their first lipid profile screening before age 11.
A fasting lipid profile is the recommended screening method. High risk is defined as a family history of high lipids or early CVD; unknown history or other CVD risk factors such as overweight, obesity, hypertension or diabetes.
XLipid Profile Once per calendar year.
A fasting lipid profile is the recommended screening method. High risk is defined as a family history of high lipids or early CVD; unknown history or other CVD risk factors such as overweight, obesity, hypertension or diabetes.
XBreast Exam Once per calendar year.
XPap Smear Once every 3 to 5 years
Pap smears are available beginning at age 21.
For women ages 30 through 65 who wish to extend the time between pap smear screenings, a pap smear will be covered every 5 years when it is
accompanied by HPV screenings.
For females 12-20, these services are available and may be covered under the appropriate medical portion of your benefit plan. These should be
performed based on patient and provider discretion.
Pap smear screenings are not available after 65 years of age.
XPelvic Exam Once per calendar year Pelvic Exams are available annually for women over the age of 12. These should be performed based upon patient and provider discretion.
XMammogram Once per calendar year.
Mammograms are available for females ages 35 and older. These should be performed based upon patient and provider discretion. Mammograms recommended every 2 years for ages 50-74.
XBone Density Once per lifetime.
XProstate Specific Antigen with Digital Rectal Exam Once per calendar year.
Prostate cancer high-risk individuals are defined as follows:
• Between the ages of 40-49 and are African American, or have a father or brother diagnosed
with prostate cancer at a young age
XStool for Occult Blood Once per calendar year.
XFlexible Sigmoidoscopy Colonoscopy Flexible sigmoidoscopy and colonoscopy
recommended for ages 45-75.
Additional screenings (flexible sigmoidoscopy, colonoscopy) for individuals considered to be at high risk for colorectal cancer, as outlined below, may be covered under the appropriate medical portion of your benefit plan. High-risk individuals in this category are defined as
follows:
• Strong family history of colorectal cancer or polyps (in first-degree relative younger than 60
or two first-degree relatives of any age). A first-degree relative is defined as a parent, sibling
or child.
• Known family history of colorectal cancer syndrome
• Personal history of colorectal cancer polyps
Gastroenterology consultations prior to colonoscopy are not covered under Healthy You!
Questions to Ask Your Doctor
How does my blood pressure compare to the recommended? What is one way I can improve my health? What is my goal weight? Do you have my current list of prescriptions? Are my screening tests up to date? Do I need any immunizations?
Immunizations
Select an age range to see immunizations covered under the Healthy You! Wellness Benefit based on age and gender guidelines. Ask your Primary Care Network Provider about the recommended number, frequency and which immunizations are recommended for you.
Listed below are the immunizations covered under Healthy You! based on age and gender guidelines. Ask your Primary Care Network Provider about the recommended number, frequency and which immunizations are recommended for you.
Choose Age Range
Choose Age Range
Hepatitis B (Hep B) (chronic liver inflammation, life-long complications)
Haemophilus influenzae type bB (Hib) Infections of the blood, brain, joints, or lungs (pneumonia)
Inactivated Polio (IPV)
Measles, Mumps, Rubella (MMR) (German Measles)
Varicella (Chickenpox)
Pneumococcal (PCV) Infections of the blood, brain, joints, inner ears, or lungs (pneumonia)
Influenza (Flu vaccine) (Flu and complications)
Hepatitis A (Hep A) (inflammation of the liver)
Rotavirus Birth to 9 Months (diarrhea and vomiting)
Meningococcal (Meningitis)
Human Papillomavirus (HPV) beginning at age 9
Shingles (Age 50 and older)
Human Papillomavirus (HPV) before age 27
Meningococcal up to age 55 (Meningitis)
Human Papillomavirus (HPV)
PPV Infections of blood, brain, joints, inner ears or lungs (pneumonia)
Pneumococcal (PCV) Infections of blood, brain, joints, inner ears or lungs (pneumonia)
PCV/PPV Infections of blood, brain, joints, inner ears or lungs (pneumonia)
COVID-19 Vaccine (Age 5-11) (COVID-19 virus)
COVID-19 Vaccine (COVID-19 virus)
be RxSmart
Healthy lifestyle habits can reduce your risk of developing health conditions like high cholesterol, high blood pressure or diabetes that can require prescription medications on an ongoing basis.
Often, many medications can be used to treat a medical condition, and they can have very different prices. Search for medications on our secure myBlue Member portal to find cost-effective options to discuss with your doctor. The lower the category number, the lower your cost on prescription drugs.
Category 1
Generally includes low-cost generic and same brand-name drugs.
Category 2
Generally includes higher-cost generic and many brand- name drugs.
Category 3
Generally includes brand-name and generic drugs and may have alternatives in Category 1 or 2.
Category 4
Generally includes high-cost generic drugs, high-cost technology drugs and specialty drugs.
Generally includes low-cost generic and some brand-name drugs.
Category 1
Generally includes higher-cost generic and many brand- name drugs.
Category 2
Generally includes brand-name and generic drugs and may have alternatives in Category 1 or 2.
Category 3
Generally includes high-cost generic drugs, high-cost technology drugs and specialty drugs.
Category 4
Category 1
Generally includes low-cost generic and same brand-name drugs.
Category 2
Generally includes higher-cost generic and many brand-name drugs.
Category 3
Generally includes brand-name and generic drugs and may have alternatives in Category 1 or 2.
Category 4
Generally includes high-cost generic drugs, high-cost technology drugs and specialty drugs.
The Value of Good Health and Being RxSmart
Leading a healthy lifestyle can make a big difference in your health and reduce the need for prescription drugs. Eating a healthy, balanced diet, along with regular exercise, being tobacco-free and seeing your doctor can keep you healthy. For those times when prescription drugs are needed, ask your Primary Care Network Provider about whether a lower-cost generic medication is available.
Generic prescription drugs have the same active ingredients in the same strength as their brand name equivalents. They are regulated and tested by the U.S. Food and Drug Administration for their safety and effectiveness. Being RxSmart saves you money at the pharmacy.
$
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Today, nearly 8 out of 10 prescriptions filled in the U.S. are for generic drugs.
All FDA-Approved generic drugs must be equivalent to the brand-name drug.
Many generic drugs are made in the same manufacturing plants as the brand-name drugs.
The generic manufacturer must prove its drug is the same as the brand-name drug.
The average cost of a generic drug versus its brand-name counterpart is 80-85% less.
be Tobacco-free
If you quit smoking, health improvements start right away and continue to get better with time. If you've tried before, remember: every time you try to quit, you increase your chance of succeeding.
Health Benefits of Being Tobacco-free
The health benefits of being tobacco-free can last a lifetime and can help you live a longer and more productive life.
Improved reproductive health in both men and women
Whiter teeth and fresher breath
Healthier skin with more elasticity
Better sense of smell and taste
More energy
Reduced stress levels
Nonsmokers are half as likely to be at risk for stroke. Stroke is a disruption of blood circulation to the brain that can cause death or significant disability.
An estimated 8.6 million persons in the United States have serious illnesses attributed to smoking; chronic bronchitis and emphysema account for 59% of all smoking-attributable diseases. Being tobacco-free can increase lung capacity 30 percent or more, which makes everyday tasks like walking, exercise and taking the stairs easier.
Smoking causes coronary heart disease, the leading cause of death in the United States. Cigarette smokers are 2 to 4 times more likely to develop coronary heart disease than nonsmokers. Normal heart rate and blood pressure promote good cardiovascular health.
Nonsmokers are 10 times less likely to develop Peripheral Artery Disease (PAD). Peripheral Arterial Disease (PAD) in the legs or lower extremities is the narrowing or blockage of the vessels that carry blood from the heart to the legs.
The Brain
Nonsmokers are half as likely to be at risk for stroke. Stroke is a disruption of blood circulation to the brain that can cause death or significant disability.
The Lungs
An estimated 8.6 million persons in the United States have serious illnesses attributed to smoking; chronic bronchitis and emphysema account for 59% of all smoking-attributable diseases. Being tobacco-free can increase lung capacity 30 percent or more, which makes everyday tasks like walking, exercise and taking the stairs easier.
The Heart
Smoking causes coronary heart disease, the leading cause of death in the United States. Cigarette smokers are 2 to 4 times more likely to develop coronary heart disease than nonsmokers. Normal heart rate and blood pressure promote good cardiovascular health.
The Circulatory System
Nonsmokers are 10 times less likely to develop peripheral artery disease (PAD). Peripheral Arterial Disease (PAD) in the legs or lower extremities is the narrowing or blockage of the vessels that carry blood from the heart to the legs.
Smoking causes coronary heart disease, the leading cause of death in the United States. Cigarette smokers are 2 to 4 times more likely to develop coronary heart disease than nonsmokers. Normal heart rate and blood pressure promote good cardiovascular health.
