Darlington County School District
Regional Health Screening sponsored by PEBA
On November 20, 2015, we will be hosting a regional health screening at Darlington County School District’s Admin. Building beginning at 7:00 a.m. until the last fulfilled appointment time. This screening, a $350 value in many healthcare settings, is FREE in 2015 for employees, retirees, and their covered spouses whose primary insurance coverage is the State Health Plan (Standard or Savings Plan)!!!
Within three weeks after your screening, you will receive your personal health profile, highlighting any values outside the normal range. You can even send this report to your physician or take a copy with you on your next doctor's office visit, which may save you money and keep you from duplicating tests. A detailed description of the screening components can be found online at http://www.eip.sc.gov/pp_resource_library/Guide_complete.pdf
There are two ways to register for this event!
Option 1 – Register online at the following website: http://www.eip.sc.gov/prevention/training/detail/1098/darlington-regional-screening
NOTE: The online registration is the easiest way to register for the screening. It allows you to pick your preferred time. If a time slot is already full, it will be faded out and unavailable.
Option 2 – Register by completing the attached form and return the completed form to:
Darlington County School District, Benefits Office, Administrative Building, 120 East Smith Avenue, Darlington, SC 29532
NOTE: The Benefits office will use the form to submit the online registration and will select the preferred time, if available. If the preferred time is not available, the next closest time slot will be selected for you.
If you have already participated in a health screening this plan year (January 2015 – current date), participation is still allowed for this screening at a cost of $46.00. The payment can be brought with you to the screening.
Registration for the screening is required by one of the options above by November 13, 2015.
Darlington County School District
Regional Health Screening sponsored by PEBA
Health Screening Registration Form
(if not already registered online)
______
Terms and Conditions
· There is a 12-hour fast prior to your screening (you may have water and any required medications you may be taking)
· Participants are required to complete all components of this health screening. This includes height, weight, blood pressure, blood draw, and paperwork.
· Please bring your insurance card with you the day of the screening. Your insurance card ID number will be required when filling out paperwork.
· Insurance allows for ONE Prevention Partners screening per calendar year (January-December)
· Dependent children are not eligible
* (Required Information)
Name (First and Last) *______Date of Birth *______
Home Address * ______City * ______State *______Zip *______
Work Phone * ______Home/Cell Phone ______
Email * ______
Employer * ______
I am an (check one) *: ___ employee ___ retiree ___ covered spouse
I hereby certify that I am an employee, retiree, or covered spouse whose primary insurance coverage is the State Health Plan (Standard or Savings Plan) and that I have read the terms and conditions listed above.
SIGNATURE *______
Insurance Card I.D. Number (not your SSN#) *:______
Please circle the time you prefer to attend the screening (If a time is unavailable when the registration is entered online, the closest available time slot will be selected):
7:00 a.m. 7:10 a.m. 7:20 a.m. 7:30 a.m. 7:40 a.m. 7:50 a.m.
8:00 a.m. 8:10 a.m. 8:20 a.m. 8:30 a.m. 8:40 a.m. 8:50 a.m.
9:00 a.m. 9:10 a.m. 9:20 a.m. 9:30 a.m. 9:40 a.m. 9:50 a.m.
10:00 a.m. 10:10 a.m. 10:20 a.m. 10:30 a.m. 10:40 a.m. 10:50 a.m.
11:00 a.m. 11:10 a.m. 11:20 a.m. 11:30 a.m. 11:40 a.m. 11:50 a.m.
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OPTIONAL TESTS
Below is a list of the most popular optional tests and their prices. These optional tests are not required in the basic screening because they are not recommended by the US Preventive Services Task Force for group screenings. Insurance is not filed for these tests, as they are out of pocket expenses. To add any of these tests to your basic screening, please make a check out to COHSG and present it to your healthcare provider the day of the screening.
Thyroid, 4-panel $10 Hemoglobin A1c $30 Blood Type $17
Prostate-Specific Antigen (PSA) $22 Homocysteine $42
C-Reactive Protein (CRP) $17 Vitamin D, 25-Hydroxy $56
CA-125 $30