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 44
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 44
Benefit Description
Preventive Care, Adult (cont.)
First-degree relatives are defined as: parents, siblings, and children of the member being tested. Second-degree relatives are defined as: grandparents, aunts, uncles, nieces, nephews, grandchildren, and half-siblings (siblings with one shared biological parent) of the member being tested. Relatives may be living or deceased.
Notes:
You Pay
See previous page
Preventive Care, Adult (cont.)
- Eligible members must meet at least one of the following criteria (continued):
- Members who have not been diagnosed with breast, ovarian, fallopian tube, peritoneal, pancreatic, and/or prostate cancer who meet at least one of the following family history criteria (see below for members of Ashkenazi Jewish heritage) (continued):
- A first- or second-degree relative with both breast and ovarian cancer at any age; or
- A history of breast cancer in a first- or second-degree female relative, and a history of ovarian, fallopian tube, or primary peritoneal cancer in the same or another female first- or second-degree relative; or
- A first-degree female relative with bilateral breast cancer; or
- A combination of two or more first- or second-degree female relatives with ovarian cancer regardless of age at diagnosis; or
- A history of pancreatic or prostate cancer diagnosed in a first- or second-degree relative; or
- A history of breast cancer in a male relative
- A first- or second-degree relative with both breast and ovarian cancer at any age; or
- Members of Ashkenazi Jewish heritage who have not been diagnosed with breast, ovarian, fallopian tube, peritoneal, pancreatic, and/or prostate cancer must meet one of the following family history criteria:
- Individual from a family with a known harmful mutation in BRCA1 and/or BRCA2 gene; or
- Any first-degree relative with breast or ovarian cancer; or
- A history of pancreatic or prostate cancer diagnosed in a first- or second-degree relative; or
- Two second-degree relatives on the same side of the family with breast or ovarian cancer
- Individual from a family with a known harmful mutation in BRCA1 and/or BRCA2 gene; or
First-degree relatives are defined as: parents, siblings, and children of the member being tested. Second-degree relatives are defined as: grandparents, aunts, uncles, nieces, nephews, grandchildren, and half-siblings (siblings with one shared biological parent) of the member being tested. Relatives may be living or deceased.
- Testing for large genomic rearrangements of the BRCA1 and BRCA2 genes
- Eligible members are age 18 or older; and
- Receive genetic counseling and evaluation prior to the BRCA1 and BRCA2 testing; and
- Meet BRCA testing criteria described above and on page 43.
- Eligible members are age 18 or older; and
Notes:
- Benefits for BRCA testing and testing for large genomic rearrangements of the BRCA1 and BRCA2 genes are limited to one of each type of test per lifetime whether considered a preventive screening or a diagnostic test (see page 40-41 for our coverage of diagnostic BRCA testing).
- Preventive care benefits are not available for surgical removal of breasts, ovaries, or prostate.
You Pay
See previous page
Preventive Care, Adult - continued on next page