Preventive care

To help you stay healthy, WellSense covers preventive care services for children and adults. Many screenings, immunizations and well visits are covered under your plan, depending on your age and risk factors. Consult your plan documents for more information.

wellness-fpo

EyeDoctor
Screenings
  • Alcohol misuse
  • Blood pressure and preeclampsia
  • Bone density
  • Breast cancer
    • Genetic test counseling (BRCA)
    • Mammography
    • Chemoprevention
  • Cervical cancer
  • Chlyamydia
  • Cholesterol 
  • Colorectal cancer
  • Depression, including maternal
  • Diabetes, including gestational
  • Domestic and interpersonal violence
  • Gonorrhea
  • Hepatitis
  • HIV
  • Lung cancer
  • Obesity
  • Pelvic exams and pap smears
  • Rh(D) incompatibility
  • Syphilis
  • Tobacco use
  • Tuberculosis

Immunizations

Immunizations
  • Chickenpox (Varicella)
  • COVID-19
  • Diphtheria
  • Flu (influenza)
  • Hepatitis A
  • Hepatitis B
  • Human Papillomavirus (HPV)
  • Inactivated poliovirus
  • Measles
  • Meningococcal
  • Mumps
  • Pneumococcal
  • Respiratory syncytial virus (RSV)
  • Rotavirus (RV)
  • Rubella
  • Shingles
  • Tetanus
  • Varicella
  • Whooping Cough (Pertussis)

Recommended immunizations for children (CDC)

Doctor

Well visits
  • Adults:
    • See your primary care provider (PCP) for a well visit/annual physical once per year 
  • Children:
    • Newborn: 1-week visit
    • Year one: 1, 2, 4, 6, 9, and 12 month visits
    • Year two: 15, 18, 24, and 30 month visits
    • Once per year from age 3-21


  • Get regular eye exams to detect problems early. All WellSense plans offer routine eye exams.
  • If prescribed glasses, wear them frequently. Some WellSense plans offer discounts on eyeglasses. 
  • Wear sunglasses with UV protection.
  • Eat a balanced diet rich in nutrients like omega-3 fatty acids, lutein, zinc, and vitamins C and E.
  • Reduce screen time and take regular breaks while using computers or smartphones. Consider using blue-light blocking glasses for extended screen use.
  • Use proper lighting when reading or working.
  • Protect your eyes from injury by wearing protective eyewear during sports or hazardous activities.
  • For dry eyes, use artificial tear drops or try adding moisture to the air with a humidifier.
  • Avoid smoking, which can increase the risk of age-related eye diseases. If you need help to stop smoking, Massachusetts WellSense members can ask their doctor to refer them to QuitWorks and New Hampshire WellSense members can call QuitNow NH at 800-QUIT-NOW.

  • Blurry/hazy vision
  • The need to squint to see clearly
  • Headaches caused by eyestrain
  • Difficulty focusing on objects
  • Eye irritation or pain
  • Sensitivity to light or glare
  • Peripheral (side) vision loss
  • Tunnel vision
  • Difficulty adapting to low light
Calendar
Take your medicines as prescribed
  • Know exactly how and when to take your medications.
  • Take your meds on time. Use notes or a smartphone app.
  • Have your medication with a small meal or snack to avoid side effects.
  • You may need to take the medications for a long time.
  • Talk to your doctor before stopping medications.
Pill_Bottle
Fill your medications on time
  • Set up automatic refills or refill reminders at your pharmacy,
  • Consider using our mail order pharmacy to get a three month supply of medications mailed to your home. Contact Cornerstone Health Solutions at 844-319-7588 to get started.
Pill_Bottle
Monitor your blood sugar levels
  • Blood sugar testing shows how well your medications are working or how your food intake, exercise or illnesses are affecting your blood sugar levels.
  • Check blood sugar levels using a blood glucose meter. Follow your doctor’s advice on how often you need to check your blood sugar level. Keep a record of your levels to discuss with them.
  • If you take insulin, check your blood sugar before meals and snacks as well as before and after exercise.
Moms_Meals
Know your target blood sugar range

The American Diabetes Association recommends the following target blood sugar levels:

  • Before meals: 80-130mg/dl
  • Two hours after meals: Less than 180mg/dl
These goals vary based on your age and personal health. Ask your doctor what your specific target goal should be.

WellSense vision benefits

All WellSense plans provide routine, preventive vision exams. Some offer eyeglasses (lenses and/or frames), contact lenses, and additional vision services. See your plan documents below for more details.

Plan Preventive Lenses/Frames/Contacts Vision services
Clarity
  • Preventive vision exams for children (every 12 months) and adults (every 24 months)
  • Cost-sharing = $0
  • For members ages 18 and under: one pair of conventional* lenses and frames, or one pair of contact lenses, per calendar year
  • Deductible and/or coinsurance may apply
  • Eye exams and treatment (to treat or diagnose a medical condition of the eye) are covered
  • Deductible and/or coinsurance may apply
MassHealth
  • Comprehensive eye exams for members under 21 (every 12 months) and for members 21 and over (once every 24 months)
  • Prescription and dispensing of ophthalmic materials, including eyeglasses and other visual aids, excluding contacts
  • Vision training
  • Ocular prosthesis
  • Contacts, when medically necessary, as a medical treatment for a medical condition such as keratoconus
  • Bandage lenses
Senior Care Options
  • One routine eye exam per year
  • Glaucoma screening (one per year for high risk members)
  • Screening for diabetic retinopathy (one per year for diabetic members)
  • One pair/set of eyeglasses (prescription lenses, frames, a combination of lenses and frames ) or contact lenses up to the allowed amount per calendar year is covered
  • $325 allowance per year towards the purchase of eyewear and upgrades through our vision care provider, VSP
  • Outpatient physician services for the diagnosis and treatment of diseases and injuries of the eye, including treatment for age-related macular degeneration
  • One pair of eyeglasses or contact lenses after each cataract surgery that includes insertion of an intraocular lens
New Hampshire Medicaid
  • Refraction eye exam to determine the need for eyeglasses (one per year)
  • One pair of eyeglasses per year
  • Transition lenses for members with ocular albinism
  • Contact lenses (for specific conditions only)
  • Trifocal lenses (for specific conditions only)
  • Eye care services by an ophthalmologist, optometrist or optician
  • Eye exams to diagnose and monitor medical conditions of the eye
  • Ocular prostheses, including artificial eyes and lenses
New Hampshire Medicare Advantage
  • Routine vision exam ($0 copay)
  • Medicare-covered eyewear: $0 copay
  • $150-$300 allowance every year toward the purchase of one pair of eyeglasses, contact lenses or hardware upgrades through our vision care provider, VSP
  • Medicare-covered vision services, including:
    • A yearly glaucoma screening and diabetic eye exam
    • Outpatient physician services for the diagnosis and treatment of diseases and injuries of the eye, including treatment for age-related macular degeneration
    • One pair of eyeglasses or contact lenses after each cataract surgery that includes insertion of an intraocular lens
  • Deductible and/or coinsurance may apply for all other Medicare-covered vision services

 

WellSense plan benefits

Find your specific plan's benefits using the links below.

Farsighted

Find an eye doctor

Our network includes experienced eye doctors who provide personalized care. Use our provider locator to find an eye doctor, ophthalmologist or optometrist in your plan’s optical network.