Page 14 - EPO_Member_Kit

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11
Women’s Health
Female Alliance enrollees may obtain annual well-woman examinations and all obstetrical and
gynecologic services from any Alliance-affiliated provider.
Routine Gynecologic Care Includes:
• Services provided at a standard annual gynecologic visit;
Pap test, breast and pelvic exams and a mammogram (if
recommended). There is no limit to the number of Pap tests
you may receive each year. We recommend a Pap test every
one to three years for sexually active women younger than
age 65. Women over the age of 65 with a history of normal
Pap tests may not need one every year.
• Mammograms are covered as often as your Alliance-
affiliated doctor recommends them. There are no limits on
the number received, and referrals are not required.
Routine Obstetrical Care Includes:
• All prenatal visits, standard lab tests, deliveries and one ultrasound.
• Obstetrical care is not a covered benefit for dependents under Alliance unless your plan has
the Rider.
Pregnancy is a very special time. If you think you may be pregnant, see your doctor as soon as possible,
and continue your patient/doctor relationship throughout your pregnancy with regular visits.
Breast Reconstruction
• Women who undergo mastectomies are eligible for certain breast reconstruction benefits.
We provide coverage for:
— Reconstruction of a breast that has been surgically removed by a mastectomy
— Surgery on and reconstruction of the other breast as needed to produce a
symmetrical appearance
— Prosthetics
— Complications arising from any aspect of the mastectomy, including swelling of
the surrounding tissue after surgery (lymphedema)