• I have a family history of colon cancer. It is my understanding that the HMO does not require a copayment for colon cancer screenings. When I recently had a colonoscopy, I had to pay $200. Why?
  
• How do the HMO and PPO plans cover immunizations for children? Do the plans also cover immunizations required for me to travel abroad?

Q: I have a family history of colon cancer. It is my understanding that the HMO does not require a copayment for colon cancer screenings. When I recently had a colonoscopy, I had to pay $200. Why?

A: The HMO does not require a copayment for colorectal cancer screenings. However, during a screening, if the doctor performs a medical procedure, like removing polyps, the screening changes to outpatient surgery. The HMO requires a $200 copayment for outpatient surgical procedures performed in an ambulatory surgical center and same-day inpatient surgery performed in a hospital without an overnight stay.

Colorectal cancer screenings are recommended for members 50 and older and for people who have risk factors for colorectal cancer. In addition to a colonoscopy every 10 years, colorectal cancer screenings include:

• Annual fecal occult blood test performed
  
• A flexible sigmoidoscopy with hemoccult of the stool every five years
  
  

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Q: How do the HMO and PPO plans cover immunizations for children? Do the plans also cover immunizations required for me to travel abroad?

A: The HMO and PPO plans cover routine immunizations for children. Neither plan requires a copayment through the child’s 6th birthday. Immunizations are not covered for travel outside the United States, school sports, or extracurricular or recreational activities. The chart below displays co-payments each plan requires for immunizations.

To view recommended immunization schedule chart go to: www.cdc.gov/vaccines/recs/schedules/downloads/child/2007/child-schedule-bw-print.pdf

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