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For the Pathways to Health overview, please click here.

Answers to frequently asked questions about Pathways to Health:

• A preventative well visit is a yearly appointment with a family practice, general practice, pediatric, internal medicine, geriatrics, gynecology, OB/GYN or urgent care intended to prevent illness and detect health concerns early before they become major. Addressing health issues early helps you get or stay on a healthy track and reduces the risk of developing other conditions. The District Fl Blue medical plan covers one preventative well visit per calendar year.

• Employees can verify their medical exam date on the Benefits Portal under the Wellness Tab, or by contacting their doctor or medical provider.

• The lookback period for completing a qualifying preventative wellness exam for 2024 was July 1, 2021 – June 30, 2023.

• The cut-off date for obtaining a preventative wellness exam for the 2024 calendar year coverage was June 30, 2023. 

• The lookback period for completing a qualifying preventative wellness exam for 2025 will be July 1, 2022 – June 30, 2024.

• The cut-off date for obtaining a preventative wellness exam for the 2025 calendar year coverage is June 30, 2024. 

• Employees do not need to send documentation to Risk Management.  Florida Blue will provide all verification of preventative wellness exams.

• Dependents and spouses are not required to obtain a preventative wellness exam.

• The biometric screening does not count as a preventative wellness exam.

• A preventative wellness exam through another insurance provider, previous employer or self-pay does not qualify as a preventative wellness exam for Pathways to Health.

• A preventative wellness exam using an out of network provider will count towards Pathways to Health, so long as the provider submits a qualifying preventative wellness code to Florida Blue.

• CDL physicals do not meet the qualifications of a preventative wellness exam.

• Employees can verify if they have had a preventative wellness exam by checking their Florida Blue claim portal or contacting the on-site Florida Blue representative, Martina Olson at extension 32314 or e-mail her at martina.olson@bcbsfl.com.  Please provide the date of service and name of the Doctor/medical provider in your request to Martina when requesting verification.

• Adult preventative CPT codes that qualify for a preventative wellness exam are 99385, 99386, 99387, 99395, 99396, 99397, G0438 and G0439 or Problem focused CPT codes 99201-99205, 99211-99215 billed with a preventative/routine diagnosis code.