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Kelsey-Seybold Greater Houston Plan

​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.

  1. Physician and provider care from specialists and oncologists involved in the diagnosis and treatment of cancer.
  2. Cancer-related diagnostic services, including imaging (MRI, CT, PET, X-ray, and other approved radiologic imaging services), and laboratory testing.
  3. Outpatient and inpatient treatment for cancer diagnoses, including surgical treatment, radiation therapy, and infusion therapy.
  4. Inpatient cancer care as approved by Kelsey-Seybold.
  5. Post-cancer treatment follow-up visits with specialists and oncologists, including diagnostic imaging and laboratory services ordered by treating physicians.
  6. Supportive Medicine – services that address the unique physical, psychological, and spiritual needs of patients living with serious or life-threatening illnesses.
  7. 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.

  1. Ambulance
  2. Clinical trials approved by treating physicians (partial to full coverage based on case review)
  3. Durable Medical Equipment (DME), including wheelchairs, walkers, etc.
  4. Emergency room care
  5. Genetic testing for breast, ovarian, and prostate cancer
  6. Home healthcare
  7. Hospice care at home
  8. Nutrition consultation
  9. Ostomy supplies
  10. Prosthetic devices, including mastectomy brassieres
  11. Supplies needed for feeding with formulas
  12. Urgent care visits related to cancer diagnosis
  13. Wigs
  14. Treatment for pre-existing conditions not related
  15. 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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