Included Services

What's Included in 100% Coverage for Cancer Prevention, Diagnosis, and Treatment

Plan members will receive 100% coverage with no deductibles, copays, or coinsurances for services related to the diagnosis and treatment of cancer.

INCLUDED SERVICES

The services listed below are covered in the Kelsey-Seybold Greater Houston Plan according to the regular schedule of benefits as shown in the Summary of Benefits and Coverage.

• Physician and provider care from specialists and oncologists involved in the diagnosis and treatment of cancer.
• Cancer-related diagnostic services, including imaging (MRI, CT, PET, X-ray, and other approved radiologic imaging services), and laboratory testing.
• Outpatient and inpatient treatment for cancer diagnoses, including surgical treatment, radiation therapy, and infusion therapy.
• Inpatient cancer care as approved by Kelsey-Seybold.
• Post-cancer treatment follow-up visits with specialists and oncologists, including diagnostic imaging and laboratory services ordered by treating physicians.
• Supportive Medicine – services that address the unique physical, psychological, and spiritual needs of patients living with serious or life-threatening illnesses.
• Reconstructive and plastic surgery to restore function and appearance related to cancer diagnosis.

EXCLUDED SERVICES:

These services are not covered in the Kelsey-Seybold Greater Houston Plan.

• Ambulance
• Clinical trials approved by treating physicians (partial to full coverage based on case review)
• Durable Medical Equipment (DME), including wheelchairs, walkers, etc.
• Emergency room care
• Genetic testing for breast, ovarian, and prostate cancer
• Home healthcare
• Hospice care at home
• Nutrition consultation
• Ostomy supplies
• Prosthetic devices, including mastectomy brassieres
• Supplies needed for feeding with formulas
• Urgent care visits related to cancer diagnosis
• Wigs
• Treatment for pre-existing conditions not related
• Feeding and nutritional supplements other than those provided during an in-patient stay

NOTE: Prescription drugs are covered separately through the prescription drug benefit program, and all applicable copays and deductibles apply.