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HSA Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 750 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 1250 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

No coverage for testing based on family history alone, except for testing for the breast cancer susceptibility gene (BRCA). Genetic testing is covered to establish a molecular diagnosis of an inheritable disease when all of the following criteria are met:

  • The member displays clinical features, or is at direct risk of inheriting the mutation in question (pre-symptomatic);
  • The result of the test will directly impact the treatment being delivered to the member;
  • The testing method is considered scientifically valid for identification of a genetically-linked inheritable disease; and
  • After history, physical examination, pedigree analysis, genetic counseling and completion of conventional diagnostic studies, a definitive diagnosis remains uncertain.

Preauthorization by medical plan is required.


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