Claims & Billing
Scheduling annual well-care visits

​​​​​​​When scheduling and billing for annual well-care visits, remember that Independence Blue Cross (IBX) 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 IBX 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


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​​​Benefits example

​An IBX member who visits a primary care provider (PCP) or personal physician for an annual physical on J​une 30, 2024​, does not have to wait until June 30, 2025, for another physical. The member may schedu​l​e their next physical any time on or after January 1, 2025.

Services that occur less frequently (other than once per year) adhere to a rolling calendar year. For example, when normal, a colonoscopy would be covered once every ten years.​



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Medicare Advantage benefits

Coverage for an annual wellness visit and an annual physical exam are based on a calendar year. A Medicare Advantage member who has either an annual wellness visit or an annual physical exam on June 1, 2024, does not need to wait until June 1, 2025, before receiving another one. Both frequencies reset on January 1. 

Coverage for preventive services

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

  • Commercial: #00.06.02aq: Preventive Care Services
  • Medicare Advantage: #MA00.003y: 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. Participating providers can check the member’s coverage using the Eligibility & Benefits transaction in PEAR Practice Management. If you don’t have access to the Provider Engagement, Analytics & Reporting (PEAR) portal, learn more here​.

For additional help, contact PEAR Support at 1-833-444-PEAR (1-833-444-7327). 


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