Preventive Routine Physicals

Covered expenses include charges made by your primary care physician (PCP) for routine physical exams. This includes routine vision and hearing screenings given as part of the routine physical exam. A routine exam is a medical exam given by a physician for a reason other than to diagnose or treat a suspected or identified illness or injury.

Routine physical exams may also include:

  • Evidence-based items that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force.
  • Services as recommended in the American Academy of Pediatrics/Bright Futures Guidelines for Children and Adolescents.
  • Screenings and counseling services as provided for in the comprehensive guidelines recommended by the  Health Resources and Services Administration.
  • X-rays, lab and other tests given in connection with the exam.
  • For covered newborns, an initial hospital check up.

Not covered under this Preventive Care benefit are charges for:

  • Services which are covered to any extent under any other part of McClatchy health care plans;
  • Services which are for diagnosis or treatment of a suspected or identified illness or injury;
  • Exams given during your stay for medical care;
  • Services not given by a physician or under his or her direction;
  • Psychiatric, psychological, personality or emotional testing or exams;

No. Any charges associated with a physical received beyond the plan frequency will be denied and you will be responsible for the full amount associated with the visit.

Negotiated rates cannot be applied to services when they are denied.

Absolutely!

Physicians may recommend a physical frequency that exceeds the number of visits McClatchy medical will cover has preventive.

If you are unsure of the date your last routine physical was received or if you have questions about what services are considered preventive, contact Aetna Member Services 888-492-3862. 

Well-Woman Preventive Care

Covered expenses include charges made by your physician obstetrician, or gynecologist for:

  • A routine well woman preventive exam office visit, including Pap smears. A routine well woman preventive exam is a medical exam given by a physician for a reason other than to diagnose or treat a suspected or identified illness or injury; and
  • Routine preventive care breast cancer genetic counseling and breast cancer (BRCA) gene blood testing. Covered expenses include charges made by a physician and lab for the BRCA gene blood test and charges made by a genetic counselor to interpret the test results and evaluate treatment.