Mammograms Clause Samples
The Mammograms clause establishes the requirements and provisions related to the coverage of mammogram screenings under a health insurance policy or healthcare agreement. Typically, this clause specifies the eligibility criteria, frequency, and extent of coverage for routine and diagnostic mammograms, often aligning with medical guidelines or legal mandates. For example, it may state that women over a certain age are entitled to annual screenings at no additional cost. The core function of this clause is to ensure that policyholders have access to essential breast cancer screening services, thereby promoting early detection and supporting public health objectives.
Mammograms. One baseline mammogram is covered for female Members between the ages of 35 and 39. A mammogram is available every two years for female Members between the ages of 40 and 49 and a mammogram is available every year for female Members aged 50 and older. In addition, one or more mammograms a year are available when based upon a Physician's recommendation for any woman who is at risk for breast cancer because of a personal or family history of breast cancer, because of having a history of biopsy-proven benign breast disease, because of having a mother, sister or daughter who has had breast cancer, or because a woman has not given birth before the age of 30. Mammograms are not subject to the Calendar Year Deductible or any cost-sharing.
Mammograms. Coverage will be provided for screening and diagnostic mammograms. Benefits for mammography are payable only if performed by a qualified mammography service provider who is properly certified by the appropriate state or federal agency in accordance with the Mammography Quality Assurance Act of 1992.
Mammograms. Preventive care services as follows: Prostate specific antigen (PSA); Digital-Rectal Exams (DRE) Fecal Occult Blood Test (FOBT); Sigmoidoscopies; Double Contrast Barium Enemas (DCBE); and Colonoscopies. These benefits will be subject to: Age; Family history; and Frequency guidelines. These guidelines will be determined by applying the most generous rules, as they apply to the The most recently published preventive health care guidelines as required by the Federal Department of Health and Human Services; or The state laws and regulations that govern the Group Agreement. Specialist Physician Benefits.
Mammograms. Covered at one hundred percent (100%): One (1) between age thirty-five (35) and age forty (40), then one (1) every year if considered high risk. Otherwise, from age forty (40) to age fifty (50) one (1) every other year, and from age fifty (50) and beyond one (1) every year.
Mammograms. A mammogram is an x-ray image examination of the breast(s) used to detect tumors and cysts, and to help differentiate benign and malignant disease.
a. Screening Mammogram
b. Diagnostic Mammogram