For employees with GC’s health insurance:
One of the requirements of receiving Goshen College health insurance is an annual physical with your health service provider. This includes a requirement of an annual physical for any employee spouse covered under GC health insurance.
You and your spouse (if applicable) will need to complete an annual physical between July 1 and May 31 of the benefit year. If for some reason you and/or your spouse choose to not get an annual physical the penalty is a monthly charge of $30 each deducted from your pay in the following academic year.
Your health provider will need to use certain diagnostic codes to record the visit for insurance purposes. We feel that the requirement of an annual physical allows you to establish a working relationship with your health provider regarding your overall health care needs. This FAQ document provides more information, including specific diagnostic codes your health provider should use to note your visit as an annual physical. This physical is covered 100% by insurance and has no co-pay. Additional services or tests may require a copay or out of pocket expense toward your deductible.
FAQ
1. What should I tell my doctor about the purpose of my medical visit?
Call it your annual physical. This kind of physical allows employees to work with their doctor to receive the screenings relevant to their personal situation and to address their specific health concerns.
2. Is the visit covered under our employee health plan?
Yes, both a routine annual physical (with diagnosis code Z00.00 or Z00.01) and a pelvic exam for women (with diagnosis code Z01.411 or Z01.419) are preventive benefits that are covered at 100% under our health plan. You will not incur an expense unless you received services during the visit that go beyond a routine physical.
3. Are there specific tests or screenings that must be done during the physical?
No, we are not requiring any specific tests to be conducted during the physical. If lab work is ordered for any medical reason other than preventive, its cost will apply to your deductible.
4. Do employees or their doctors need to report anything to Goshen College after the physical?
No. There are no forms or lab results to submit. Any tests, results and/or applicable treatment plans are between you and your physician.
5. Where can I have my physical done in order to meet the requirement?
Your physical may be done by a primary care physician, a nurse practitioner, physician’s assistant or at an urgent care facility.
6. How are covered spouses or dependents affected by this new initiative?
An annual physical for any employee spouse covered under GC health insurance is required.
7. How are employees who are not covered by our health plan affected by this change?
They are not affected. This change is not applicable to them.
8. When must the physical be done?
The physical must be completed between July 1 and May 31.
It is not uncommon for physicians’ schedules for routine appointments to be filled several months in advance. You are responsible to make your appointment in time to ensure you receive the credit for the annual physical.
9. How can I find out if my physical since July 1 was covered?
Your Explanation of Benefits (EOBs) claims records reflect processed medical charges can be found at highmarkbcbs.com.
10. How will Goshen College know if the annual physical requirement has been met?
When your health provider files your insurance forms, they should be using one or even several of these codes. Everence will then send us the list of employees who have had their physicals based on these codes. A report will be produced on May 31 (based on claims records) to verify which employees had an annual physical. This report will not contain any details of the visit. The report will simply verify the processing of an annual physical and will be used to determine if the requirement is met for each employee.
Below are a list of procedure codes that meet the guidelines for the Annual Physical requirement:
| Patient NEW to the office |
Patient established w/ the office
|
||
| Office visit for medicine ages 18-39 | 99385 | 99395 | Preventative |
| Office visit for medicine ages 40-65 | 99386 | 99396 | Preventative |
| Office visit for medicine ages 65+ | 99387 | 99396 | Preventative |
| GYN exam – any age | May also use G0101 | ||
11. What if I have more questions?
Please contact Human Resources.
Information on labs that are eligible on the Highmark Preventive Lab Schedule:
The following are some common preventive labs (codes included) that are ordered by physicians and would be eligible on the Highmark Preventive Schedule. The diagnosis code has to be Z00.00 or Z00.01 in order to be covered on the Highmark Preventive Schedule.
- Fasting blood glucose (82947 or 82948)
- Cholesterol Screening: (82465, 83721, 83718 and 84478 OR 80061 in place of the 1st four codes)
- Complete Blood Count (85025, 85027)
- Urinalysis (81001 & 81002)
- PSA (84152 & 84153)
- General Health Panel (80050)
- Comprehensive Metabolic Plane (80053)
Other codes that can be used for preventive coverage include the following codes for office visits:
- 99385
- 99386
- 99387
- 99395
- 99396
- 99397
- G0101 (this is a code for a pelvic and breast exam)
If the lab is billed with a diagnosis code related to a chronic condition such as hypertension or high cholesterol the labs will be processed to deductible.
Codes that are not covered at 100% on Highmark Preventive Schedule:
- Complete blood count (85025, 85027)
- Thyroid (84443, 84436)
- Vitamin D (82306)
- Combination lab codes (80047, 80048, 80050, 80051, 80053)
Other items that are not covered at 100% on the Highmark Preventive Schedule:
- EKG
- Routine chest x-ray