2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 42
 
Benefit Description

Preventive Care, Adult (cont.)

 
  • Screening for diabetes mellitus
  • Screening for hepatitis B
  • Screening for hepatitis C
  • Screening for alcohol/substance use disorder

    Note: See pages 58 and 100 for our coverage of smoking, tobacco, and E-cigarette cessation treatment.

     
  • Screening for chlamydial infection
  • Screening for gonorrhea infection
  • Screening for human immunodeficiency virus (HIV) infection
  • Screening for syphilis infection
  • Screening for latent tuberculosis infection
  • Administration and interpretation of a Health Risk Assessment (HRA) questionnaire (see Definitions)

    Note: As a member of FEP Blue Focus, you have access to the Blue Cross and Blue Shield HRA, called the “Blue Health Assessment” questionnaire. See Section 5(h) for more information.

You Pay
See previous page
 
Benefit Description
  • Colorectal cancer tests, including:
    • Fecal occult blood test
    • Colonoscopy, with or without biopsy (see page 60 for our payment levels for diagnostic colonoscopies)
    • Sigmoidoscopy
    • Double contrast barium enema
    • DNA analysis of stool samples
       
  • Prostate cancer tests – Prostate Specific Antigen (PSA) test
     
  • Cervical cancer screening tests
    • Pap tests of the cervix
    • Human papillomavirus (HPV) tests of the cervix
       
  • Screening mammograms, including mammography using digital technology
Note: Preventive care benefits for each of the services listed above are limited to one per calendar year.

Note: We pay preventive care benefits on the first claim we process for each of the above tests you receive in the calendar year. Regular coverage criteria and benefit levels apply to subsequent claims for those types of tests if performed in the same year.

 
  • Low-dose CT screening for lung cancer (limited to one per year, for adults ages 55 to 80, with a history of tobacco use)
     
  • Osteoporosis screening for women age 65 and over or women ages 50 to 65 who are at increased risk
     
  • Ultrasound for abdominal aortic aneurysm for adults, ages 65 to 75, limited to one screening per lifetime

You Pay
Preferred: Nothing (no deductible)

Non-preferred (Participating/Non-participating): You pay all charges

Note: When care is provided by a Non-preferred laboratory and/or radiologist, as stated on page 18 for an exception, you pay:

 
  • Participating laboratories or radiologists: Nothing (no deductible)
     
  • Non-participating laboratories or radiologists: The difference between our allowance and the billed amount (no deductible)

Note: See Section 5(c) for our payment levels for covered cancer screenings and ultrasound screening for abdominal aortic aneurysm billed for by Member or Non-member facilities and performed on an outpatient basis.
 
 
Preventive Care, Adult - continued on next page