2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage 5 Medical Benefits Chart Services that are covered for you What you must pay when you get these services Cardiovascular disease testing There is no coinsurance, copayment, or Blood tests for the detection of cardiovascular disease (or deductible for cardiovascular disease abnormalities associated with an elevated risk of testing that is covered once every five cardiovascular disease) once every five years (60 months). years. Cervical and vaginal cancer screening Covered services include: There is no coinsurance, copayment, or • For all women: Pap tests and pelvic exams are covered deductible for Medicare-covered once every 24 months. preventive Pap and pelvic exams. • If you are at high risk of cervical or vaginal cancer or you are of childbearing age and have had an abnormal Pap test within the past three years: One Pap test every 12 months. Chiropractic services (physician-referred)† Covered services include: • We cover only manual manipulation of the spine to correct $20 per visit subluxation. ♦ These Medicare-covered services are provided by a network chiropractor. For the list of network chiropractors, please refer to the Provider Directory. Colorectal cancer screening The following screening tests are covered: • Colonoscopy has no minimum or maximum age limitation and is covered once every 120 months (10 years) for There is no coinsurance, copayment, or patients not at high risk, or 48 months after a previous deductible for a Medicare-covered flexible sigmoidoscopy for patients who are not at high risk colorectal cancer screening exam. for colorectal cancer, and once every 24 months for high If your doctor finds and removes a risk patients after a previous screening colonoscopy or polyp or other tissue during the barium enema. colonoscopy or flexible sigmoidoscopy, • Flexible sigmoidoscopy for patients 45 years and older. the screening exam becomes a Once every 120 months for patients not at high risk after diagnostic exam and you pay $0. the patient received a screening colonoscopy. Once every 48 months for high risk patients from the last flexible sigmoidoscopy or barium enema. • Screening fecal-occult blood tests for patients 45 years and older. Once every 12 months. † 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. 1-877-221-8221 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.