2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 59
Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women
with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune
system may continue to have screening as long as they are in good health.
(e)
Women who have had a total hysterectomy (removal of the uterus and cervix) may choose to stop
having cervical cancer screening, unless the surgery was performed as a treatment for cervical cancer
or precancer. Women who have had a hysterectomy without the removal of the cervix may continue to
follow the guidelines above.
Prostate Cancer
(a) Beginning at age 50, both the prostate-specific antigen (PSA) blood test and digital rectal examination
(DRE) may be offered annually to men who have at least a 10-year life expectancy.
(b)
Men at high risk (African-American men and men with a strong family history of one or first degree
relatives (father, brothers) diagnosed at an early age) may begin testing at age 45.
(c)
Men at even higher risk, due to multiple first-degree relatives affected at an early age, may begin testing
at age 40.
Endometrial (Uterine) Cancer
(a) For women with or at high risk for hereditary nonpolyposis colon cancer (HNPCC), annual screening
may be eligible for endometrial cancer with endometrial biopsy beginning at age 35.
Mammograms
(a) Routine preventative mammograms (both traditional mammograms and breast tomosynthesis (3D
mammograms)) may be payable as follows: (a) yearly mammograms starting at age 40 and one (1)
secondary follow-up mammogram to that yearly mammogram when required by a Physician; and (b)
clinical breast exams (CBE) may be part of a periodic health exam every 3 years for women in their
20s and 30s and every year for women 40 and over.
BRCA and Genomic Testing
(a) Medically Necessary molecule susceptibility testing for breast and/or epithelial ovarian cancer (BRCA
testing) may be covered for high risk adults.
(b) Medically Necessary standard care genomic testing for certain types of cancer may be covered.
If a diagnosis is indicated after any routine screening procedure, the screening will still be payable under the
routine cancer screening benefit, however, all charges related to the diagnosis (except the initial screening)
will be payable as any other Illness.
(48) Routine Care (POS Provider Only): Routine care age 19 and over, including, but not limited to, the office
visit, lab tests, x-rays, routine testing, vaccinations or inoculations, pap smears, mammograms, colon exams
and PSA testing. If a diagnosis is indicated after a routine exam, the exam will still be payable under the
routine care benefit, however, all charges related to the diagnosis (except the initial exam) will be payable as
any other Illness. Eligible expenses will be payable as shown in the Medical Schedule of Benefits.
Any routine cancer screening procedures which fall outside the parameters as listed under Routine Cancer
Screenings will be payable under this Routine Care benefit.
(49) Routine Eye Examination: Routine eye examination and refraction including the related office visit. Eligible
expenses will be payable as shown in the Medical Schedule of Benefits.
(50) Routine Newborn Care: Routine newborn care including Hospital nursery expenses and routine pediatric
care while confined following birth will be payable as shown in the Medical Schedule of Benefits.
If the newborn is ill, suffers an Injury or requires care other than routine care, benefits will be provided on the
same basis as any other eligible expense, provided the newborn is enrolled as an eligible Dependent.
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