Under the 2006 health benefits plan for Penn State Milton S. Hershey Medical Center employees, preventive care services are covered at 100 percent with no charge against an employee's deductible. Services such as adult exams, pediatric routine exams, well-baby visits and annual gynecological exams are covered in full, not subject to the deductible or co-pays, if participants stay in the Medical Center's Home Network or Capital Blue Cross Network.
Screening colonoscopies also are covered under the Medical Center's preventive care schedule; however, there are some important guidelines employees and their dependants should keep in mind.
If a colonoscopy is ordered as a preventive test and nothing is found, then the colonoscopy is coded as preventive and paid at 100 percent.
If the colonoscopy is ordered as a preventive test and something is found -- such as polyps -- but nothing is done at the time of the colonoscopy, then it is coded as preventive and paid at 100 percent.
However, if the colonoscopy is ordered as a preventive test and something is found -- such as polyps -- and a procedure is done, then the colonoscopy is coded as diagnostic rather than preventive and will be charged against the deductible. According the Medical Center's benefits office, this final scenario is considered by Medicare to be the standard medical coding practice for colonoscopies.
Health benefits coverage of preventive services has not changed from previous years. What has changed, however, is how diagnostic services are covered under the Medical Center's group health plan. Diagnostic services performed in the Medical Center's Home Network are covered at 100 percent after the deductible has been met and preventive services are covered at 100 percent with no charge against the deductible.