Preventive Health Screening Guidelines
This information is meant to be a guide only and does not replace the advice of your doctor.
The screenings listed are based on recommendations from the American Cancer Society, Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices, U.S. Preventive Services Task Force and other nationally recognized authorities available at the time of publication.
Please verify covered benefits by referring to your SHBP Member Handbook. You may also verify covered benefits by calling Member Services at 1-800-414-SHBP (7427). Most preventive screenings are covered only if provided by doctors, other health care professionals and facilities participating in your health plan’s network.
- Herpes zoster (shingles) vaccine: All adults ages 60 years and older should receive a single dose, regardless of history of herpes zoster. SHBP members are eligible to receive the vaccine at age 50 years.
- Pneumococcal Polysaccharide vaccine (PPSV): Recommended for all adults ages 65 years and older.
- Seasonal influenza vaccine (flu shot): Recommended annually for everyone ages 6 months and older.
- Tetanus and diphtheria, pertussis (Td/Tdap) booster: Tdap should replace a single dose of Td for all adults. Adults should receive the Td booster every 10 years.
A one-time Abdominal aortic aneurysm (AAA) screening by ultrasonography in men ages 65 to 75 years who have ever smoked.
- Diabetes screening: The American Diabetes Association recommends screening for diabetes in adults age 45 years or older and in anyone with risk factors regardless of age or as recommended by a doctor or health care professional.
- Lipid screening: A fasting lipoprotein profile (total cholesterol, LDL-C, HDL-C and TG) is recommended in all adults over the age of 20 years once every five years or more frequently if risk factors are present or as recommended by a doctor or health care professional.
Bone Density (DEXA Screening)
Recommended for all women ages 65 years and older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. Men should discuss risk factors with a doctor or other health care professional.
- Clinical breast exam (CBE): Women in their 20s and 30s should have a CBE as part of their health exam, preferably every three years. Women ages 40 years and older should have a CBE performed annually by a doctor or health care professional.
- Mammography: Women age 40 years and older should receive one baseline mammogram. An annual mammogram is recommended for women beginning at age 40 years, or younger for women at high risk.
- Women ages 21 to 29 years: Pap test every three years.
- Women ages 30 to 65 years: co-testing with HPV test and Pap test every five years (preferred) or every three years if testing by Pap test alone.
- Women older than 65 years: discuss cervical cancer screening with a doctor or health care professional.
Colorectal Cancer Screening
Beginning at age 50 years, men and women who are at average risk for developing colorectal cancer (or at an age deemed appropriate by the doctor or other health care professional for those who are at increased risk) should have one of the following screenings:
- Fecal Occult Blood Test (FOBT) with at least 50 percent test sensitivity for cancer every years. A colonoscopy should be done if test results are positive.
- Fecal Immunochemical Test (FIT) with at least 50 percent test sensitivity for cancer every years. A colonoscopy should be done if test results are positive.
- Flexible sigmoidoscopy every five years. A colonoscopy should be done if test results are positive.
- Double-Contrast Barium Enema (DCBE) every five years. A colonoscopy should be done if test results are positive.
- Computed Tomography Colonography (virtual colonoscopy) every five years. A colonoscopy should be done if test results are positive.
- Colonoscopy every 10 years. Direct visualization through colonoscopy is regarded as the most accurate method of diagnosis.
Height, Weight, Body Mass Index (BMI) and Blood Pressure
Annually for all age groups; more frequently if warranted.
Discuss symptoms of hearing loss with your doctor.
Hearing examinations to determine the need for hearing aids or the need to adjust a hearing aid are not covered.
Prostate Cancer Screening
According to the American Cancer Society, asymptomatic men who have at least a 10-year life expectancy should have the opportunity to make an informed decision with their doctors about whether to be screened for prostate cancer after receiving information about the uncertainties, risks and potential benefits associated with prostate cancer screening. Prostate cancer screening should not occur without an informed decision-making process. Men at average risk should receive this information at age 50 years. Men at higher risk, including African-American men and men who have first-degree relatives (father or brother) diagnosed with prostate cancer before age 65 years, should receive this information from age 40 to 45 years.
Skin Health/Mole Exam
The American Cancer Society (ACS) recommends a cancer-related checkup by a doctor or health care professional, including a skin examination, during a periodic health examination for people ages 20 years or older. The ACS also recommends monthly skin self-examination by all individuals. Any new, unusual or progressively changing lesion in appearance of color, size and/or shape should be examined by a doctor or other health care professional.
The American Academy of Ophthalmology (AAO) recommends a comprehensive adult medical eye evaluation, including tests for glaucoma, with the frequency depending on the patient’s age, health status and other risk factors for glaucoma or conditions of the eye. AAO recommends a comprehensive eye exam every one to two years for persons ages 65 years or older who have no risk factors.
One routine vision wellness exam per calendar year is covered under the SHBP plan; however, eyeglasses and lenses are not a covered benefit.