Reminder: Guidelines for annual physicals

Under the terms of the Affordable Care Act, Blue Cross Blue Shield of Michigan and Blue Care Network commercial members typically qualify for an annual physical.

Here are some other guidelines to keep in mind:

• Some members may qualify for more than one physical each year, depending on their age, sex and the type of plan they have.
• Government guidelines for commercial coverage don’t apply to members who are part of the Federal Employee Program^®, Michigan Public School Employees’ Retirement System, UAW Retiree Medical Benefits Trust or other retiree or self-funded groups that don’t follow government rules.
• Members with one of our Medicare Advantage plans (Medicare Plus Blue℠ PPO or BCN Advantage℠) qualify for annual wellness visits. Those who are new to Medicare can receive a “welcome to Medicare” preventive visit. For more details, see the January Record article.

BCN
BCN recently changed the frequency for preventive screenings to a calendar year for its commercial members to align with Blue Cross PPO plans and to allow members who deferred their screenings due to COVID-19 to have more flexibility in future scheduling.

This means members can schedule their routine screenings at any time during the year regardless of when they had the screening in the previous year. This applies to preventive screenings that members schedule annually, such as mammograms.

As a reminder, health care providers can schedule a physical for BCN members any time throughout the year. There are no limits to the frequency of physicals for HMO patients.

For more information, see the article on Page 1 of the September – October issue of BCN Provider News.

Medicare Advantage
BCN Advantage℠ and Medicare Plus Blue℠ PPO follow guidelines set by the Centers for Medicare & Medicaid Services. More information on the frequency of Medicare screenings is available at cms.gov.**

Benefits and eligibility
Because of variations in coverage, it’s always best to check benefits and eligibility for your patients on web-DENIS.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.