Independence members – and their providers – often have questions when scheduling appointments for annual preventive service visits, especially well-care visits. Independence commercial and Medicare Advantage members have coverage for one well-care visit every calendar year. They do not need to wait 365 days between visits. A member can schedule an annual well-care visit/physical exam at any time during each calendar year.

Commercial benefits

Coverage for annual well-care visits is based on a calendar year regardless of the commercial member’s benefit period. Whether an Independence member has a calendar year benefit period or a group-funded contract year benefit period, the benefit time period for preventive services remains the same. Self-funded group benefit periods may vary, but this does not affect well-care annual visits.  

Note: Pediatric members may have coverage for more frequent visits depending on their age.

Annual well-care visits include services such as:

• physical/wellness exam
• depression screening
• risk assessment for sexually transmitted diseases

Medicare Advantage benefits

Coverage for an annual preventive physical exam is based on a calendar year. A Medicare Advantage member who has an annual physical on May 1, 2019, does not need to wait until May 1, 2020, before receiving another physical. The annual physical exam frequency resets on January 1. 

Coverage for preventive services

All benefit limits are subject to age requirements as outlined in Independence medical policies:  

• Commercial: #00.06.02aa: Preventive Care Services
• Medicare Advantage: #MA00.003l: Preventive Care Services

To access these policies, visit our Medical Policy Portal.

Verifying member benefits

It is important for providers to verify benefit coverage prior to scheduling and/or performing preventive services. Providers can check the member’s coverage through the Eligibility and Benefits Inquiry transaction on the NaviNet^® web portal (NaviNet Open) by selecting Additional Benefit Provisions and then choosing Routine/Preventive Care.

For instructions on how to use this transaction, refer to the Eligibility and Benefits Inquiry Guide, which can be found under User guides and webinars in the NaviNet Open section.

Learn more

If you have additional questions about member benefits and annual preventive service visits, please call Customer Service at 1-800-ASK-BLUE (1-800-275-2583).

NaviNet^® is a registered trademark of NantHealth, an independent company.