- One baseline mammogram exam for women at any age
- A routine mammogram exam every year for women age 40 and older
- A routine mammogram exam at such age and intervals as deemed medically necessary by a woman’s health care professional in the case of a woman who is under age 40 years and has a family history of breast cancer or other breast cancer risk factors
- An ultrasound evaluation, a magnetic resonance imaging (MRI) scan, a three‐dimensional (3D) mammography, or other additional testing of an entire breast or breasts, after a baseline mammogram exam for routine purposes, if the mammogram demonstrates extremely dense breast tissue, if the mammogram is abnormal within any degree of breast density including not dense, moderately dense, heterogeneously dense, or extremely dense breast tissue, or if the patient has additional risk factors for breast cancer including, but not limited to, family history of breast cancer, prior personal history of breast cancer, positive genetic testing, extremely dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology, or other indications as determined by the patient’s health care professional¹
- Out‐of‐pocket costs apply if performed by an out‐of‐network doctor or if the services are diagnostic or treatment‐based, not preventive.
Bone Mass Density (BMD): Age 65 years and older, and younger women who are at risk.
- Pap test every 3 years for ages 21 to 65 years or Pap test with Human papillomavirus (HPV) screening every 5 years for ages 30 to 65 years
- Out‐of‐pocket costs apply if performed by an out‐of‐network doctor
Yearly total skin exams for ages 27 and older; every three years for younger adults at risk.