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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.

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