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HealthPartners

Coverage criteria policies

Health education

These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Does not require prior authorization.

Coverage

Covered subject to the indications listed below.

Health education services that are covered

  1. Education for either preventive services or the management of chronic health problems which are provided during a physician/nurse visit and are not part of a formal health education class. Examples include, but are not limited to:
    1. Diabetic education
    2. Early pregnancy education which occurs as a part of your routine prenatal visits with your OB provider.
    3. Nutrition education (Also see related policy-Dietician Consultation.)
    4. Breast self examination
    5. Cholesterol education
    6. Instruction regarding medications
  2. Diabetes education classes are covered for standard outpatient diabetes self-management and training programs. Group or individual sessions are covered.

Health education services that are not covered under your benefit (but are offered by HealthPartners either without charge or for a discounted fee):

The Health Promotion Department section of the HealthPartners.com website has health information available for members Please check the web site for the unique educational offerings.

Definitions

A standard Outpatient Diabetes Self-management and Training Program is a service that educates patients in the successful self-management of diabetes. It includes education about self-monitoring of blood glucose, diet, exercise, and sometimes medication (oral agents and/or insulin). The treatment plan is developed specifically for the patient, which helps engage and motivate patients to use the knowledge and skills in effective self-management. It follows the national standards for diabetes self-management education programs and American Diabetes Association (ADA) review criteria. The hours of instruction may vary based on individual needs. An average education program is about 12 hours.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

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Policy activity

  • 01/01/1994 - Date of origin
  • 04/30/2018 - Effective date
Review date
  • 11/2017
Revision date
  • 04/02/2018

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