Will preventive care be eligible for sharing?
Preventive screening, as outlined below, is subject to PRA and co-share.
• Women: Pap test—one every three years from age 21-65
Mammogram—one every year for ages 45-54, every two years starting at age 55
• Men: PSA test—one every year, starting at age 45
• All: Colonoscopy—one every 10 years starting at age 45 or one every five years for members at high risk
• As it pertains to eligible preventive care for both men and women, both the test and coordinated office visit will be eligible for sharing.
• Note: Bills are processed in the order they are received to apply allowances and sharing.
Exceptions are made for testing outside of the above timelines when determined to be medically necessary and not related to a pre-existing condition.