Routine Physical Exam

Provider Type

  • Physicians 
  • Participating Physician Groups (PPG)

Annual routine physical examinations differ from periodic health examinations, which are also covered under the Health Net Medicare Advantage (MA) plans. An annual routine physical exam is one that is not physician-directed and is done for the purpose of checking a member's general health in the absence of symptoms. Examples include exams taken to obtain or maintain employment, licenses or insurance, or exams administered at the request of a third party, such as a school, camp or sports-affiliated organization.

One annual routine physical exam requested by the member without medical condition indications is covered along with any related X-ray and laboratory procedures ordered or approved by the physician. The exam is subject to scheduled copayments.

Routine physical exam coverage allows the member to request services not otherwise medically indicated. Refer to the specific plan in the Schedule of Benefits and Summary of Benefits for routine physical examination coverage frequency based on the member's age.