Ontario Health Insurance Plan (OHIP) Billing Codes Information and Procedures for Claiming the Cumulative Preventative Care Bonus

Size: px
Start display at page:

Download "Ontario Health Insurance Plan (OHIP) Billing Codes Information and Procedures for Claiming the Cumulative Preventative Care Bonus"

Transcription

1 Ontario Health Insurance Plan (OHIP) Billing Codes Information and Procedures for Claiming the Cumulative Preventative Care Bonus Eligible Patient Enrolment Model (PEM) physicians may receive Cumulative Prevention Care Bonuses for maintaining specified levels of preventive care to their enrolled patients. There are five preventive care categories for which an individual physician may earn an annual bonus. Three of these categories are for breast, cervical, and colorectal cancer screening. 1. Pap Smear This bonus is based on the percentage of the target population who has received a Pap smear in the 30 months prior to March 31 st of the fiscal year for which the bonus is being claimed. The target population consists of enrolled female patients who are between 35 and 69 years of age, inclusive, as of March 31 st, of the fiscal year for which the bonus is being claimed (i.e. a patient who turns 70 on March 15 th, 2011 would not be considered part of the 2010/2011 Pap smear target population). 2. Mammography This bonus is based on the percentage of the target population who has received a mammogram in the 30 months prior to March 31st of the fiscal year for which the bonus is being claimed. The target population consists of enrolled female patients who are between 50 and 69 years of age, inclusive, as of March 31st of the fiscal year for which the bonus is being claimed (i.e. a patient who turns 70 on March 15 th, 2011 would not be considered part of the 2010/2011 Mammography target population). 3. Colorectal Cancer Screening This bonus is based on the percentage of the target population who has received a Fecal Occult Blood Test (FOBT) in the 30 months prior to March 31st of the fiscal year for which the bonus is being claimed. The target population consists of enrolled patients who are between 50 and 74 years of age, inclusive, on March 31 st of the fiscal year for which the bonus is being claimed (i.e. a patient who turns 75 on March 15 th, 2011 would not be considered part of the 2010/2011 Colorectal Cancer Screening target population).

2 Below is a list of the Fee Schedule Codes that are applicable for each Cumulative Preventive Care Bonus Category: Cumulative Preventive Care Bonus Category Pap smear Mammography Colorectal Cancer Screening Applicable Services G365A, L713A, L643A, E430A, Q678A, tracking code Q011A, and exclusion code Q140A X185A, X185B, X185C, tracking code Q131A, and exclusion code Q141A G004A, L179A, L181A, Q700A, tracking code Q133A, and exclusion code Q142A Below is a list of tracking and exclusion codes that can be submitted using the normal billing practices to submit Fee for Service claims and premium codes applicable to their agreement. The fee billed should be zero dollars. Category Tracking Code Exclusion Code and Criteria Pap smear Q130A Not applicable Mammography Q131A Q141A Exclusions apply for women who had had a mastectomy, or who are being treated for clinical breast disease. Colorectal Cancer Screening Q133A Q142A Exclusions apply for patients with known cancer being followed by a physician; with known inflammatory bowel disease; who have had a colonoscopy within the last 10 years; with a history of malignant bowel disease; or with Colorectal Cancer any disease requiring regular colonoscopies for Q133A Screening surveillance purposes. Please note that although the above change has increased the length of time that the colonoscopy is valid for exclusion, the Q142A must still be submitted every 30 months to be reported on the Target Population and Service Reports.

3 Steps to Claim for your Cumulative Preventive Care Bonuses 1. Calculate the coverage level as follows: (Number of Covered Patients*/[Number of patients on the Preventive Care/Target Population Service Report Excluded Patients**] ) x 100 *Covered patients are those patients eligible Target Population that received the preventive are services previously defined. **Physicians may adjust the number of patients oh their Preventive Care/Target Population Service Report and remove any patients who meet the exclusion criteria for Pap smear, mammography, and colorectal cancer screening. 2. Determine the appropriate Q Code for the bonus and coverage level. Preventive Care Category Achieved Compliance Rate Pap smear 60% 65% 70% 75% 80% Mammography 55% 60% 65% 70% 75% Colorectal Cancer 15% Screening 20% 40% 50% 60% 70% Fee Payable $220 $440 $660 $1320 $2200 $220 $440 $770 $1320 $2200 $220 $440 $110 $2200 $3300 $4000 Service Enhancement Code Q105A Q106A Q107A Q108A Q109A Q110A Q111A Q112A Q113A Q114A Q118A Q119A Q120A Q121A Q122A Q123a See the following document for more information:

4 Other Billing Codes: Q005A Q150 Q152 Q043A Code Definition Fee For the phone/letter invitation for a $6.86 colon cancer check FOBT test (FHN/FHO) For counseling and directly giving $7.00 patients a colon cancer check branded FOBT kit For review and follow up of a $5.00 completed colon cancer check FOBT kit Accepting a new patient with a $ $ positive FOBT/diagnosed cancer depending on age Please see next page for chart to hang in your clinic.

5 ColonCancerCheck FOBT Re-Orders and Expiry Dates The ColonCancerCheck (CCC) FOBT kit, as with most medical devices, has an expiry date. The expiry date is found on the bottom of the FOBT card on the side that says Do Not Open. Kits received by a community laboratory after the expiration date will not be processed. Patients who submit an expired kit for processing will be advised by mail from ColonCancerCheck that the kit has expired and that they will need to repeat the test with a valid kit. Patients will be advised to obtain a replacement kit from their family physician or nurse practitioner, or from Telehealth Ontario or their local pharmacy if they do not have a family physician or nurse practitioner. What do you need to do? 1. Check your current inventory of FOBT kits to ensure that they are not expired or about to expire. The expiry date of your kits should be at least three months away to allow time for the kit to be completed and returned for testing. 2. Dispose of any kits which are expired or will expire in three months or less. CCC FOBT kits do not contain hazardous materials. You may throw away the kit in your garbage and/or recycle the pieces in the kit as is appropriate for your community. 3. Point out the expiry date to patients when you give them a CCC FOBT kit. Ask them to complete the kit at least a month before the kit expires. Explain that the kit will not be processed if it has expired. 4. Reorder new CCC FOBT kits as needed. Order kits through your community laboratory supplier. Follow the link: 5. If a patient informs you that they have an expired kit, please make it as easy as possible for them to get a replacement kit.

6 CANCER BILLING CODES Breast Cancer (Mammogram) Billing Codes Q131A Ages To help calculate your year-end bonus Q141A Exclusion for Mammogram Cervical Cancer (Pap Testing) Billing Codes Q011A Ages To help calculate your year-end bonus Q140A Exclusion for Pap Colorectal Cancer Billing Codes Q005A For the phone/letter invitation for a colon cancer check FOBT test (FHN/FHO only) $6.86 Q150 For counseling and directly giving patients a colon cancer check branded FOBT kit $7.00 Q152 For review and follow-up of a completed colon cancer check FOBT kit $5.00 Q142A An exclusion code for those who do not need a FOBT test (i.e. previous colonoscopy) To help calculate your year-end bonus Q043A Accepting a new patient with a positive FOBT/diagnosed cancer $150-$230 (depending on age) Smoking Cessation Counseling Billing Codes Q042A Smoking cessation counseling fee (patient enrolment models only) $7.50 E079 Smoking cessation premium $15.40 K039 Smoking cessation follow-up visit $33.45

MINISTRY OF HEALTH AND LONG-TERM CARE Primary Health Care Team FACT SHEET. Family Health Team Blended Salary Model for Physicians

MINISTRY OF HEALTH AND LONG-TERM CARE Primary Health Care Team FACT SHEET. Family Health Team Blended Salary Model for Physicians MINISTRY OF HEALTH AND LONG-TERM CARE Primary Health Care Team FACT SHEET To: Title: Family Health Teams Family Health Team Blended Salary Model for Physicians Date: December 4, 2006 Eligible Family Health

More information

Billing & Payment Guide for Blended Salary Model (BSM) Physicians Family Health Teams, Primary Health Care Ministry of Health and Long-Term Care

Billing & Payment Guide for Blended Salary Model (BSM) Physicians Family Health Teams, Primary Health Care Ministry of Health and Long-Term Care Billing & Payment Guide for Blended Salary Model (BSM) Physicians Family Health Teams, Primary Health Care Ministry of Health and Long-Term Care February 2012 Version 1.0 Table of Contents Introduction

More information

Billing & Payment Guide for Family Health Organization (FHO) Physicians

Billing & Payment Guide for Family Health Organization (FHO) Physicians Billing & Payment Guide for Family Health Organization (FHO) Physicians Blended Models - Primary Health Care Ministry of Health and Long-Term Care September 2011 Ministry of Health and Long-Term Care Copies

More information

Summary of Cancer Prevention and Screening Benefits of the Affordable Care Act (ACA) in Kentucky for health professionals

Summary of Cancer Prevention and Screening Benefits of the Affordable Care Act (ACA) in Kentucky for health professionals Summary of Cancer Prevention and Screening Benefits of the Affordable Care Act (ACA) in Kentucky for health professionals Talk with patients about ü Potential benefits, harms, and unknowns of cancer ü

More information

Preventive services process, Practice Solutions. Generating reminder letters with MD verification

Preventive services process, Practice Solutions. Generating reminder letters with MD verification Preventive services process, Practice Solutions. Generating reminder letters with MD verification By: Michelle Greiver MD CCFP Prepared for: North York Family Health Team, Summer 2012 Funding: Cancer Care

More information

MINISTRY OF HEALTH AND LONG-TERM CARE Primary Health Care Team FACT SHEET

MINISTRY OF HEALTH AND LONG-TERM CARE Primary Health Care Team FACT SHEET MINISTRY OF HEALTH AND LONG-TERM CARE Primary Health Care Team FACT SHEET Title: Billing and Payment Information for Rural and Northern Physician Group Agreement (RNPGA) Group Physicians Date: As of June

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Royce TJ, Hendrix LH, Stokes WA, Allen IM, Chen RC. Cancer screening rates in individuals with different life expectancies. JAMA Intern Med. Published online August 8, 24.

More information

Guide to Physician Compensation

Guide to Physician Compensation Family Health Teams Advancing Family Health Care Guide to Physician Compensation Updated September 2009 Version 3.0 Table of Contents Purpose...3 Background...3 The Role of Family Physicians in the Family

More information

Aetna Life Insurance Company

Aetna Life Insurance Company Aetna Life Insurance Company Hartford, Connecticut 06156 Amendment Policyholder: Group Policy No.: Effective Date: UNIVERSITY OF PENNSYLVANIA POSTDOCTORAL INSURANCE PLAN GP-861472 This Amendment is effective

More information

Oregon Survey Instrument

Oregon Survey Instrument Oregon Survey Instrument Cancer Genetic Insurance Questions for Insurers Q1a. Do you have written policies on your coverage of cancer genetic testing, counseling, and follow-up procedures for breast and

More information

Colorado Cancer Coalition Priorities: 2016 2018

Colorado Cancer Coalition Priorities: 2016 2018 Option 3 of 10: Screening & Early Detection: Screening Rates Presenter: Toni Panetta, MA, Director of Mission Programs, Susan G. Komen Colorado Goal 5: Objective 5.1: Objective 5.2 Focus Area: Focus Area:

More information

Cancer Screening 22M 36% 56% Only 56% of uninsured women aged 50 74 are up-to-date with mammography screening. Colorectal Cancer Breast Cancer

Cancer Screening 22M 36% 56% Only 56% of uninsured women aged 50 74 are up-to-date with mammography screening. Colorectal Cancer Breast Cancer July 2010 22M 22 million adults aged 50 75 need to be screened for colorectal cancer, and 7 million women aged 50 74 need to be screened for breast cancer. Cancer Screening Colorectal Cancer Breast Cancer

More information

IN-NETWORK MEMBER PAYS. Out-of-Pocket Maximum (Includes a combination of deductible, copayments and coinsurance for health and pharmacy services)

IN-NETWORK MEMBER PAYS. Out-of-Pocket Maximum (Includes a combination of deductible, copayments and coinsurance for health and pharmacy services) HMO-OA-CNT-30-45-500-500D-13 HMO Open Access Contract Year Plan Benefit Summary This is a brief summary of benefits. Refer to your Membership Agreement for complete details on benefits, conditions, limitations

More information

Oklahoma Higher Education Employee Insurance Group Educational Meeting Welcome!

Oklahoma Higher Education Employee Insurance Group Educational Meeting Welcome! Oklahoma Higher Education Employee Insurance Group Educational Meeting Welcome! The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional

More information

Manitoba EMR Data Extract Specifications

Manitoba EMR Data Extract Specifications MANITOBA HEALTH Manitoba Data Specifications Version 1 Updated: August 14, 2013 1 Introduction The purpose of this document 1 is to describe the data to be included in the Manitoba Data, including the

More information

COVERAGE SCHEDULE. The following symbols are used to identify Maximum Benefit Levels, Limitations, and Exclusions:

COVERAGE SCHEDULE. The following symbols are used to identify Maximum Benefit Levels, Limitations, and Exclusions: Exhibit D-3 HMO 1000 Coverage Schedule ROCKY MOUNTAIN HEALTH PLANS GOOD HEALTH HMO $1000 DEDUCTIBLE / 75 PLAN EVIDENCE OF COVERAGE LARGE GROUP Underwritten by Rocky Mountain Health Maintenance Organization,

More information

MBS items (10994, 10995) for Pap smears and Preventive Checks taken by a Practice Nurse on behalf of a GP

MBS items (10994, 10995) for Pap smears and Preventive Checks taken by a Practice Nurse on behalf of a GP MBS items (10994, 10995) for Pap smears and Preventive Checks taken by a Practice Nurse on behalf of a GP Medicare item numbers 10994 and 10995 apply to Pap smears and preventive checks provided by a practice

More information

Billing & Payment Guide for Family Health Organization (FHO) Physicians Opting for Solo Payment

Billing & Payment Guide for Family Health Organization (FHO) Physicians Opting for Solo Payment Billing & Payment Guide for Family Health Organization (FHO) Physicians Opting for Solo Payment Blended Models Primary Health Care Ministry of Health and Long-Term Care November 2014 Version 1.0 Introduction

More information

Preventive services process, Nightingale on Demand EMR. Entering data consistently and generating reminder letters with MD verification

Preventive services process, Nightingale on Demand EMR. Entering data consistently and generating reminder letters with MD verification Preventive services process, Nightingale on Demand EMR Entering data consistently and generating reminder letters with MD verification By: Michelle Greiver MD CCFP Prepared for: North York Family Health

More information

Health Care Administrators

Health Care Administrators Health Care Administrators January 21, 2005 Depend on HCA to be your resource for news and information. Page 1 of 2 1 Important Clarifications Related to Health Savings Accounts You ve asked for more information

More information

Data Standards, Data Cleaning and Data Discipline. Insight November 24, 2008

Data Standards, Data Cleaning and Data Discipline. Insight November 24, 2008 Data Standards, Data Cleaning and Data Discipline Designing the Next Generation of EMRs Insight November 24, 2008 InfoClin Inc 2006. All Rights Reserved. Agenda Why is data quality important? Why data

More information

Clinical Indicator Ages 19-29 Ages 30-39 Ages 40-49 Ages 50-64 Ages 65+ Frequency of visit as recommended by PCP

Clinical Indicator Ages 19-29 Ages 30-39 Ages 40-49 Ages 50-64 Ages 65+ Frequency of visit as recommended by PCP SCREENING EXAMINATION & COUNSELING UPMC Health Plan Clinical Indicator Ages 19-29 Ages 30-39 Ages 40-49 Ages 50-64 Ages 65+ Annually Physical Exam and Counseling 1 Blood Pressure 2 At each visit. At least

More information

Fact Sheet: The Affordable Care Act s New Rules on Preventive Care July 14, 2010

Fact Sheet: The Affordable Care Act s New Rules on Preventive Care July 14, 2010 Fact Sheet: The Affordable Care Act s New Rules on Preventive Care July 14, 2010 Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of 10 deaths among Americans each year

More information

inflammation of the pancreas and damage to the an increased risk of hypertension, stroke and Table 7.1: Classification of alcohol consumption

inflammation of the pancreas and damage to the an increased risk of hypertension, stroke and Table 7.1: Classification of alcohol consumption H E A LT H SURVEY Alcohol Consumption 7 Alcohol Consumption N AT I O N A L Introduction Excessive alcohol consumption is associated with inflammation of the pancreas and damage to the an increased risk

More information

Cancer Screening. Robert L. Robinson, MD, MS. Ambulatory Conference SIU School of Medicine Department of Internal Medicine.

Cancer Screening. Robert L. Robinson, MD, MS. Ambulatory Conference SIU School of Medicine Department of Internal Medicine. Cancer Screening Robert L. Robinson, MD, MS Ambulatory Conference SIU School of Medicine Department of Internal Medicine March 13, 2003 Why screen for cancer? Early diagnosis often has a favorable prognosis

More information

CANCER AND MEDICARE A CHARTBOOK

CANCER AND MEDICARE A CHARTBOOK CANCER AND MEDICARE A CHARTBOOK February 2009 PREPARED BY: Lisa Potetz Health Policy Alternatives, Inc. Leticia Flores DeWilde American Cancer Society Cancer Action Network (ACS CAN) ACKNOWLEDGEMENTS We

More information

HEALTH INSURANCE CHOICES FOR AMERICAN INDIANS

HEALTH INSURANCE CHOICES FOR AMERICAN INDIANS HEALTH INSURANCE CHOICES FOR AMERICAN INDIANS HEALTH INSURANCE IS AN IMPORTANT RESOURCE THAT CAN KEEP YOU AND YOUR FAMILY HEALTHY. If you have ongoing health issues, health insurance can help pay for treatment

More information

Cancer in North Carolina 2013 Report

Cancer in North Carolina 2013 Report Cancer in North Carolina 2013 Report January 2014 Updated by Central Cancer Registry Cancer in North Carolina Purpose Cancer is the leading cause of death in North Carolina even though cancer mortality

More information

Benefits Collaborative Policy Statement WOMEN S HEALTH SERVICES

Benefits Collaborative Policy Statement WOMEN S HEALTH SERVICES Page 1 uf 5 The services listed below are not inclusive of all services available to women on Medicaid, but WOMEN S HEALTH SERVICES Benefits Collaborative Policy Statement Women s health services are preventative

More information

FEATURES NETWORK OUT-OF-NETWORK

FEATURES NETWORK OUT-OF-NETWORK Schedule of Benefits Employer: The Vanguard Group, Inc. ASA: 697478-A Issue Date: January 1, 2014 Effective Date: January 1, 2014 Schedule: 3B Booklet Base: 3 For: Choice POS II - 950 Option - Retirees

More information

Who? Physicians, physician groups, health care services, health care professionals

Who? Physicians, physician groups, health care services, health care professionals Simply Charting Who? Physicians, physician groups, health care services, health care professionals What? A website for sharing: Charting templates PDFs EMR-specific custom forms When? www.simplycharting.com

More information

PLAN DESIGN AND BENEFITS - New York Open Access EPO 1-10/10

PLAN DESIGN AND BENEFITS - New York Open Access EPO 1-10/10 PLAN FEATURES Deductible (per calendar year) $1,000 Individual $3,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Member cost sharing for certain services,

More information

Examples of good screening tests include: mammography for breast cancer screening and Pap smears for cervical cancer screening.

Examples of good screening tests include: mammography for breast cancer screening and Pap smears for cervical cancer screening. CANCER SCREENING Dr. Tracy Sexton (updated July 2010) What is screening? Screening is the identification of asymptomatic disease or risk factors by history taking, physical examination, laboratory tests

More information

2015-16 TRS-ActiveCare Medical Plans

2015-16 TRS-ActiveCare Medical Plans 2015-16 TRS-ActiveCare Medical Plans PISD Contribution for full-time employees Full-Time Employee s Monthly Cost TRS-ActiveCare 1-HD PPO Total Monthly Cost Employee Only $341.00 $259.00 $82.00 Employee

More information

PREVENTIVE HEALTHCARE GUIDELINES INTRODUCTION

PREVENTIVE HEALTHCARE GUIDELINES INTRODUCTION PREVENTIVE HEALTHCARE GUIDELINES INTRODUCTION Health Plan of Nevada and Sierra Health and Life suggest that health plan members get certain screening tests, exams and shots to stay healthy. This document

More information

New York Small Group Indemnity Aetna Life Insurance Company Plan Effective Date: 10/01/2010. PLAN DESIGN AND BENEFITS - NY Indemnity 1-10/10*

New York Small Group Indemnity Aetna Life Insurance Company Plan Effective Date: 10/01/2010. PLAN DESIGN AND BENEFITS - NY Indemnity 1-10/10* PLAN FEATURES Deductible (per calendar year) $2,500 Individual $7,500 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Member cost sharing for certain services,

More information

Preventive Services Explained

Preventive Services Explained Preventive Services Explained Medicare covers many preventive care services without charge. Most of these services have been recommended by the U.S. Preventive Services Task Force. However, which beneficiaries

More information

Screening for Cancer in Light of New Guidelines and Controversies. Christopher Celio, MD St. Jude Heritage Medical Group

Screening for Cancer in Light of New Guidelines and Controversies. Christopher Celio, MD St. Jude Heritage Medical Group Screening for Cancer in Light of New Guidelines and Controversies Christopher Celio, MD St. Jude Heritage Medical Group Screening Tests The 2 major objectives of a good screening program are: (1) detection

More information

PLAN DESIGN AND BENEFITS POS Open Access Plan 1944

PLAN DESIGN AND BENEFITS POS Open Access Plan 1944 PLAN FEATURES PARTICIPATING Deductible (per calendar year) $3,000 Individual $9,000 Family $4,000 Individual $12,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being

More information

Accreditation Application CEO Cancer Gold Standard 2010

Accreditation Application CEO Cancer Gold Standard 2010 Accreditation Application CEO Cancer Gold Standard 2010 Company:Massachusetts Mutual Life Insurance Company Number of US Employees:6,642 file:///c:/users/therese/documents/ceo%20round%20table/gold%20standard/archive%20online/massachusettsmutualfinancialgroup/mass%20mutual

More information

Cost Sharing Definitions

Cost Sharing Definitions SU Pro ( and ) Annual Deductible 1 Coinsurance Cost Sharing Definitions $200 per individual with a maximum of $400 for a family 5% of allowable amount for inpatient hospitalization - or - 50% of allowable

More information

Performance Measures for the Nebraska State Health Improvement Plan

Performance Measures for the Nebraska State Health Improvement Plan Nebraska State Improvement Plan 2013-2016 Vision: Working together to improve the health and quality of life for all individuals, families, and communities across Nebraska. Performance Measures for the

More information

lifeline why cancer patients depend on medicare for critical coverage

lifeline why cancer patients depend on medicare for critical coverage lifeline why cancer patients depend on medicare for critical coverage Prepared by: Holly Stockdale American Cancer Society Cancer Action Network Kristi Guillory American Cancer Society Cancer Action Network

More information

Medicare Updates Massachusetts Health Care Training Forum. October 2012

Medicare Updates Massachusetts Health Care Training Forum. October 2012 Medicare Updates Massachusetts Health Care Training Forum October 2012 1 Topics Covered Overview of Medicare A, B & C Newest Preventive Services Medicare Part D 2013 Standard Benefit Impact of ACA on the

More information

An ANALYSIS of Medicare Benefits per the 2016 Medicare and You Handbook & The State of Delaware's Special Medicfill Plan Benefits

An ANALYSIS of Medicare Benefits per the 2016 Medicare and You Handbook & The State of Delaware's Special Medicfill Plan Benefits An ANALYSIS of Medicare Benefits per the 2016 Medicare and You Handbook & The State of Delaware's Special Medicfill Plan Benefits The chart below presents the list of benefits covered by Medicare, and

More information

Total Health Quality Indicators For Providers 2015

Total Health Quality Indicators For Providers 2015 Total Health Quality Indicators For Providers 2015 Adult- Preventive Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 BMI Assessment BMI Recording 18-74 yrs Yearly G8417, G8418, G8420

More information

Michigan Electrical Employees Health Plan Benefits & Eligibility-at-a Glance Supplement to Medicare - Medicare Enrollees

Michigan Electrical Employees Health Plan Benefits & Eligibility-at-a Glance Supplement to Medicare - Medicare Enrollees Medicare Coverage BCBSM Supp Coverage Preventive Services 12 months, if age 50 and older Colonoscopy - one per calendar year 1 0 years (if at high risk every 24 months) approved amount**, once per flu

More information

Cancer screening: indications, benefits and myths

Cancer screening: indications, benefits and myths Cancer screening: indications, benefits and myths Silvia Deandrea Institute for Health and Consumer Protection Public Health Policy Support Unit Healthcare Quality Team Joint Research Centre The European

More information

An Action Guide for Engaging Employers and Professional Medical Organizations

An Action Guide for Engaging Employers and Professional Medical Organizations Increasing Quality Colorectal Cancer Screening and Promoting Screen Quality: An Action Guide for Engaging Employers and Professional Medical Organizations U.S. Department of Health and Human Services,

More information

My Health Alliance Standard PPO Plan

My Health Alliance Standard PPO Plan My Health Alliance Standard PPO Plan COVERED BENEFITS AND LIMITATIONS The following health care services are covered under this Policy subject to the Copayments, Coinsurance, Deductibles and Plan Year

More information

PLAN DESIGN AND BENEFITS HMO Open Access Plan 912

PLAN DESIGN AND BENEFITS HMO Open Access Plan 912 PLAN FEATURES Deductible (per calendar year) $1,000 Individual $2,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Member cost sharing for certain services

More information

Health Maintenance Guidelines for Women

Health Maintenance Guidelines for Women Health Maintenance Guidelines for Women Customize your plan: These guidelines apply to healthy women in the general population. The right plan for your care may differ based on your medical history, family

More information

Re: Implementation of the 2008 Physician Services Agreement Changes Effective October 1, 2010

Re: Implementation of the 2008 Physician Services Agreement Changes Effective October 1, 2010 To: Published By: Physicians, Hospitals, Clinics and Laboratories Health Services Branch Date Issued: November 1, 2010 Bulletin #: 4520 Re: Implementation of the 2008 Physician Services Agreement Changes

More information

Texas Health Insurance Coverage for Prevention and Screening of Cancer, Cardiovascular Disease, and Diabetes

Texas Health Insurance Coverage for Prevention and Screening of Cancer, Cardiovascular Disease, and Diabetes Texas Health Insurance Coverage for Prevention and Screening of Cancer, Cardiovascular Disease, and Diabetes Phyllis Gingiss, Dr.P.H. Victoria Mosier, M.A. Sandra Coombs Khurram Shahzad, B.S. June 2007

More information

PLAN DESIGN AND BENEFITS Basic HMO Copay Plan 1-10

PLAN DESIGN AND BENEFITS Basic HMO Copay Plan 1-10 PLAN FEATURES Deductible (per calendar year) Member Coinsurance Not Applicable Not Applicable Out-of-Pocket Maximum $5,000 Individual (per calendar year) $10,000 Family Once the Family Out-of-Pocket Maximum

More information

Your Guide to Medicare s Preventive Services

Your Guide to Medicare s Preventive Services Your Guide to Medicare s Preventive Services C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S This is the official government booklet with important information about: What disease

More information

health insurance Starting at $62.50 per month

health insurance Starting at $62.50 per month health insurance Starting at $62.50 per month Exclusive student health plan for: Academic Year 2012 2013 Student Blue benefit plan information outlined within this booklet is subject to approval from the

More information

This publication was developed and produced with funding from the Centers for Disease Control and Prevention under a cooperative agreement.

This publication was developed and produced with funding from the Centers for Disease Control and Prevention under a cooperative agreement. This publication was developed and produced with funding from the Centers for Disease Control and Prevention under a cooperative agreement. Suggested Citation Centers for Disease Control and Prevention.

More information

January 1, 2015 December 31, 2015 Summary of Benefits. Advantra (HMO) H3928-001 80.06.360.1-LA1

January 1, 2015 December 31, 2015 Summary of Benefits. Advantra (HMO) H3928-001 80.06.360.1-LA1 January, 205 December 3, 205 Summary of Benefits H3928-00 80.06.360.-LA Y0022_205_H3928_00_LA Accepted 9/204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of what we

More information

Aetna Life Insurance Company Hartford, Connecticut 06156

Aetna Life Insurance Company Hartford, Connecticut 06156 Aetna Life Insurance Company Hartford, Connecticut 06156 Extraterritorial Certificate Rider (GR-9N-CR1) Policyholder: The TLC Companies Group Policy No.: GP-811431 Rider: West Virginia ET Medical Issue

More information

Health Plans Coverage Summary

Health Plans Coverage Summary www.hr.msu.edu/openenrollment Faculty & Staff Health Plans Coverage Summary PREVENTIVE SERVICES Health Maintenance Exam (1) Annual Gynecological Exam Pap Smear Screening (lab services only) Mammography

More information

Using Wolf EMR for Panel Identification and Screening

Using Wolf EMR for Panel Identification and Screening Using Wolf EMR for Panel Identification and Screening Part I Begin Panel Identification Before you begin panel processes, it is useful to have some data to inform your starting point. Note: Useful Help

More information

Diabetes Health Plan Member Guide

Diabetes Health Plan Member Guide Diabetes Health Plan Member Guide Welcome UnitedHealthcare Diabetes Health Plan Welcome to the Diabetes Health Plan. Our goal is to ensure you are getting the most out of your program. Please use this

More information

2010 QARR QUICK REFERENCE GUIDE Adults

2010 QARR QUICK REFERENCE GUIDE Adults 2010 QARR QUICK REFERENCE GUIDE Adults ADULT MEASURES (19 through 64 years) GUIDELINE HEDIS COMPLIANT CPT/ICD9 CODES DOCUMENTATION TIPS Well Care Access to Ambulatory Care Ensure a preventive or other

More information

colon cancer Talk to your doctor about getting tested for colon cancer. They know how to prevent and you can, too. Take a look inside.

colon cancer Talk to your doctor about getting tested for colon cancer. They know how to prevent and you can, too. Take a look inside. 2006, American Cancer Society, Inc. No. 243900 Rev.01/08 The American Cancer Society is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem

More information

Stay Healthy. In the Know. Screenings you and your family need. Protect yourself against health care fraud. www.aultcare.com

Stay Healthy. In the Know. Screenings you and your family need. Protect yourself against health care fraud. www.aultcare.com good health FALL 2015 YOUR FAST TRACK TO LIVING WELL Stay Healthy Screenings you and your family need In the Know Protect yourself against health care fraud www.aultcare.com TELL US HOW WE ARE DOING Whether

More information

Understanding Health Insurance. Your Guide to the Affordable Care Act

Understanding Health Insurance. Your Guide to the Affordable Care Act Understanding Health Insurance Your Guide to the Affordable Care Act Summary Health insurance may seem like a luxury if you are on a tight budget. But protecting your health and your family is one of the

More information

Summary of Benefits Community Advantage (HMO)

Summary of Benefits Community Advantage (HMO) Summary of Benefits Community Advantage (HMO) January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list

More information

Preventive Health Services

Preventive Health Services understanding Preventive Health Services For the most current version of this document, visit www.wellwithbluemt.com or www.bcbsmt.com. Preventive health services include evidence-based screenings, immunizations,

More information

la lotta al cancro non ha colore Screening Let s play ahead against tumors

la lotta al cancro non ha colore Screening Let s play ahead against tumors la lotta al cancro non ha colore la lotta al cancro non ha colore Screening Let s play ahead against tumors Why this booklet? The word cancer screening indicates the tests for the early detection of cancer.

More information

HNE Premier 1 (HMO) and HNE Premier 2 (HMO)

HNE Premier 1 (HMO) and HNE Premier 2 (HMO) 2016 Medicare Advantage Summary of Benefits HNE Premier 1 (HMO) and HNE Premier 2 (HMO) January 1, 2016 - December 31, 2016 H8578_2016_429 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2016 SECTION I

More information

[2015] SUMMARY OF BENEFITS H1189_2015SB

[2015] SUMMARY OF BENEFITS H1189_2015SB [2015] SUMMARY OF BENEFITS H1189_2015SB Section I You have choices in your health care One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare). Original Medicare

More information

Aetna Golden Medicare Plan

Aetna Golden Medicare Plan Aetna Golden Medicare Plan More Benefits Than Original Medicare 7A-20908 (US) (10/02) We Are Here To Serve You In order to make your health care decisions easier, we have provided some helpful information

More information

BENEFIT PLAN. What Your Plan Covers and How Benefits are Paid. Prepared Exclusively for ConocoPhillips

BENEFIT PLAN. What Your Plan Covers and How Benefits are Paid. Prepared Exclusively for ConocoPhillips BENEFIT PLAN Prepared Exclusively for ConocoPhillips What Your Plan Covers and How Benefits are Paid PPO Medical, Pharmacy, and Comprehensive Dental Inpatriate Plan Aetna Life Insurance Company Booklet-Certificate

More information

Sub Health Insurance Option Food Service - New Hire Memo

Sub Health Insurance Option Food Service - New Hire Memo MESQUITE ISD BENEFITS Sub Health Insurance Option Food Service - New Hire Memo Welcome to the Mesquite ISD family! If you are a new substitute, you must enroll in or decline medical coverage within 31

More information

Anna Haring, University of Texas School of Medicine in San Antonio. Site Placement: CentroMed, San Antonio, TX. Introduction

Anna Haring, University of Texas School of Medicine in San Antonio. Site Placement: CentroMed, San Antonio, TX. Introduction Title: An effort to increase enrollment in cancer screening procedures Anna Haring, University of Texas School of Medicine in San Antonio Site Placement: CentroMed, San Antonio, TX Introduction Cervical

More information

FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits. FirstMedicare Direct PPO Plus (PPO)

FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits. FirstMedicare Direct PPO Plus (PPO) FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits FirstMedicare Direct PPO Plus (PPO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties 1 P age SECTION I - INTRODUCTION TO SUMMARY

More information

As Reported by the Senate Health, Human Services and Aging Committee. 127th General Assembly Regular Session Sub. S. B. No. 278 2007-2008 A B I L L

As Reported by the Senate Health, Human Services and Aging Committee. 127th General Assembly Regular Session Sub. S. B. No. 278 2007-2008 A B I L L As Reported by the Senate Health, Human Services and Aging Committee 127th General Assembly Regular Session Sub. S. B. No. 278 2007-2008 Senator Coughlin Cosponsors: Senators Stivers, Mumper, Spada, Miller,

More information

HEALTHCARE REFORM PREVENTIVE MEDICATIONS LIST NO COST-SHARE PREVENTIVE MEDICATIONS

HEALTHCARE REFORM PREVENTIVE MEDICATIONS LIST NO COST-SHARE PREVENTIVE MEDICATIONS The Patient Protection and Affordable Care Act (PPACA), also know as HealthCare Reform, includes coverage for preventive health care services and certain medication with no out-of-pocket. The Department

More information

Medicare Options For Retiree/Direct Bill Members

Medicare Options For Retiree/Direct Bill Members Open Enrollment 2014 State Employee Health Plan Medicare Options For Retiree/Direct Bill Members Comparison Chart 2 2013 **Cover photo is titled Road into the Field from the Postcards from Kansas collection

More information

Cancer Screening and Early Detection Guidelines

Cancer Screening and Early Detection Guidelines Cancer Screening and Early Detection Guidelines Guillermo Tortolero Luna, MD, PhD Director Cancer Control and Population Sciences Program University of Puerto Rico Comprehensive Cancer Center ASPPR Clinical

More information

Greater Tompkins County Municipal Health Insurance Consortium

Greater Tompkins County Municipal Health Insurance Consortium WHO IS COVERED Requires Covered Member to be Enrolled in Both Medicare Parts A & B Type of Coverage Offered Single only Single only MEDICAL NECESSITY Pre-Certification Requirement Not Applicable Not Applicable

More information

Preventive Care Services Health Care Reform The following benefits are effective beginning the first plan year on or after Sept.

Preventive Care Services Health Care Reform The following benefits are effective beginning the first plan year on or after Sept. Coding Summary for Providers NOTE THE FOLLOWING: The purpose of this document is to provide a quick reference of the applicable codes for UnitedHealthcare plans that cover preventive care services in accordance

More information

Reliability and predictable costs for individuals and families

Reliability and predictable costs for individuals and families INDIVIDUAL & FAMILY PLANS HEALTH NET HMO PLANS Reliability and predictable costs for individuals and families If you re looking for a health plan that s simple to use and easy to understand, you ve found

More information

Medicare s Preventive Care Services. Manage Your Chronic Kidney Disease (CKD stages 3-4) with Diet

Medicare s Preventive Care Services. Manage Your Chronic Kidney Disease (CKD stages 3-4) with Diet s Preventive Care Services Manage Your Chronic Kidney Disease (CKD stages 3-4) with Diet What do the kidneys do? Your kidneys have important jobs to do in your body. Two of the kidneys most important jobs

More information

ScreenWise. Breast, Cervical, and Hereditary Cancer Screenings OCTOBER 28, 2015

ScreenWise. Breast, Cervical, and Hereditary Cancer Screenings OCTOBER 28, 2015 ScreenWise Breast, Cervical, and Hereditary Cancer Screenings OCTOBER 28, 2015 ScreenWise Three programs working together to bring quality screening services to Oregon residents Why we all do this work

More information

Cancer Facts for Women

Cancer Facts for Women 2006, American Cancer Society, Inc. No.200700-Rev.03/08 The American Cancer Society is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem

More information

PLAN DESIGN AND BENEFITS - Tx OAMC 2500 08 PREFERRED CARE

PLAN DESIGN AND BENEFITS - Tx OAMC 2500 08 PREFERRED CARE PLAN FEATURES Deductible (per calendar year) $2,500 Individual $5,000 Individual $7,500 3 Individuals per $15,000 3 Individuals per Unless otherwise indicated, the Deductible must be met prior to benefits

More information

2015 Medicare Advantage Summary of Benefits

2015 Medicare Advantage Summary of Benefits 2015 Medicare Advantage Summary of Benefits HNE Medicare Premium No Rx and HNE Medicare Basic No Rx January 1, 2015 - December 31, 2015 H8578_2015_034 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2015

More information

PLAN DESIGN AND BENEFITS - Tx OAMC Basic 2500-10 PREFERRED CARE

PLAN DESIGN AND BENEFITS - Tx OAMC Basic 2500-10 PREFERRED CARE PLAN FEATURES Deductible (per calendar year) $2,500 Individual $4,000 Individual $7,500 Family $12,000 Family 3 Individuals per Family 3 Individuals per Family Unless otherwise indicated, the Deductible

More information

Comparison of Health Care Plans Metro Interagency Insurance Program Effective Date: July 1, 2015

Comparison of Health Care Plans Metro Interagency Insurance Program Effective Date: July 1, 2015 Comparison of Health Care Plans Metro Interagency Insurance Program Effective Date: July 1, 2015 Wellmark Blue Cross Blue Shield Customer Service: 1-800-277-8380 Participating Provider Directory Information:

More information

Presented by Excellus BlueCross BlueShield, a nonprofit independent licensee of the BlueCross BlueShield Association. Life has a plan.

Presented by Excellus BlueCross BlueShield, a nonprofit independent licensee of the BlueCross BlueShield Association. Life has a plan. Presented by Excellus BlueCross BlueShield, a nonprofit independent licensee of the BlueCross BlueShield Association. Life has a plan. It's hard to believe that another year has gone by. We want to thank

More information

Welcome to the Student Health & Wellness Services (SH&WS)

Welcome to the Student Health & Wellness Services (SH&WS) Student Health Insurance Plan Information 2014 2015 Welcome to the Student Health & Wellness Services (SH&WS) Cleveland State University offers health care to all students of the University community.

More information

HEALTH SAVINGS PPO PLAN (WITH HSA) - COLUMBUS PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2016 AETNA INC.

HEALTH SAVINGS PPO PLAN (WITH HSA) - COLUMBUS PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2016 AETNA INC. HEALTH SAVINGS PPO PLAN (WITH HSA) - COLUMBUS PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2016 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible

More information

Medicare At A Glance. State Health Insurance Assistance Program (SHIP)

Medicare At A Glance. State Health Insurance Assistance Program (SHIP) 2015 Medicare At A Glance Indiana 2015 State Health Insurance Assistance Program (SHIP) Who runs the Medicare Program? The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that runs

More information

Routine Preventive Services. Covered by Medicare 2012

Routine Preventive Services. Covered by Medicare 2012 Routine Preventive Services Covered by Medicare 2012 Brook Golshan, CPC, ACS-EM 2/20/2012 1 Preventive Services Covered by Medicare 2012 Covered by Medicare Part B: Original/Direct Medicare Most of the

More information

Greater Tompkins County Municipal Health Insurance Consortium

Greater Tompkins County Municipal Health Insurance Consortium WHO IS COVERED Requires both Medicare A & B enrollment. Type of Coverage Offered Single only Single only MEDICAL NECESSITY Pre-Certification Requirement None None Medical Benefit Management Program Not

More information

PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC

PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC PLAN FEATURES Deductible (per calendar year) $0 Deductible Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Deductible is NOT applicable to Hearing Aid Reimbursement,

More information

Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare

Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare Annual Notice of Changes for 2016 You are currently enrolled as a member of Essentials Choice Rx 25 (HMO-POS). Next year, there will

More information

Preventive Health Guidelines

Preventive Health Guidelines Preventive Health Guidelines As of April 2010 What is your plan for better health? Make this year your best year for overall wellness. Your health benefits plan may cover early detection screenings and

More information