6 2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage Medical Benefits Chart Services that are covered for you What you must pay when you get these services • Multitarget stool DNA for patients 45 to 85 years of age and not meeting high risk criteria. Once every 3 years. • Blood-based Biomarker Tests for patients 45 to 85 years of age and not meeting high risk criteria. Once every 3 years. • Barium enema as an alternative to colonoscopy for patients at high risk and 24 months since the last screening barium enema or the last screening colonoscopy. • Barium enema as an alternative to flexible sigmoidoscopy for patients not at high risk and 45 years or older. Once at least 48 months following the last screening barium enema or screening flexible sigmoidoscopy. • Colorectal cancer screening tests include a follow-on screening colonoscopy after a Medicare-covered non- invasive stool-based colorectal cancer screening test returns a positive result. • Procedures performed during a screening colonoscopy (for example, removal of polyps). • Colonoscopies following a positive gFOBT or FIT test or a $0 flexible sigmoidoscopy screening. Note: All other colonoscopies are subject to the applicable cost-sharing listed elsewhere in this chart. Dental accidental injury $35 per visit (See the Dental Accidental Injury Rider in the EOC for additional information.) Depression screening There is no coinsurance, copayment, or We cover one screening for depression per year. The deductible for an annual depression screening must be done in a primary care setting that can screening visit. provide follow-up treatment and/or referrals. Diabetes screening There is no coinsurance, copayment, or We cover this screening (includes fasting glucose tests) if deductible for the Medicare-covered you have any of the following risk factors: High blood diabetes screening tests. pressure (hypertension), history of abnormal cholesterol and triglyceride levels (dyslipidemia), obesity, or a history of † Your provider must obtain prior authorization from our plan. * Your cost-sharing for these services or items doesn't apply toward the maximum out-of-pocket amount. kp.org