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Medicare Eligible Retiree Members: Preventive Benefits

Adult Routine Physical Exams and Preventive Care (age 18 and over): Annual physical is covered. Also covers the “Welcome to Medicare” routine exam during the first 12 months a member is enrolled in Medicare Part B.

Mammography: Individuals over age 40 are eligible for one routine mammography screening per calendar year.

Routine Pap Smear and Gynecological Care: Benefits are provided for one routine Pap smear and a gynecological exam every 24 months. If you are at high risk for cervical cancer or had have an abnormal Pap test and are of childbearing age, one Pap test every 12 months.

Abdominal Aortic Aneurysm Screening: One-time screening ultrasound for people at risk.

Bone-Mass Measurements: Covered once every 24 months if medically necessary (generally, for people at risk of losing bone mass or at risk of osteoporosis).

Cardiovascular Screenings: Includes blood tests for the detection of cardiovascular disease, as medically necessary. Covered every 5 years to test your cholesterol, lipid and triglyceride levels.

HIV Screenings: For people who ask for an HIV screening test or who are at increased risk for HIV infection, one screening every 12 months. For women who are pregnant, up to three screenings during pregnancy.

Screenings: Contact your Medicare HMO or PPO for screenings that are covered.

Preventive Benefits: The Plan covers the following preventive services:

For Members age 45 and over:

  • Fecal occult blood test or fecal immunochemical test - every 12 months
  • Sigmoidoscopy (or screening barium enema as an alternative) - every 48 months
  • DNA based colorectal screening - every 3 years
  • Screening colonoscopy every 10 years (not within 48 months of a screening sigmoidoscopy) - No minimum or maximum age limitation

For Members age 50 and over:

  • Prostate Specific Antigen (PSA) Testing - every 12 months

Adult Immunizations The Plan covers the following adult immunizations:

  • Pneumonia vaccine
  • Flu shots
  • Hepatitis B vaccine if you are at high risk or intermediate risk of getting Hepatitis B
  • Shingles vaccine (Shingrix and Zostavax) covered according to Medicare guidelines under your Prescription Drug Plan with a copay
  • Other vaccines if you are at risk

This a partial list. See the REHP Handbook for more information