Pillar #4: Prevention, Screening and Early Detection

Key Messages:

4a. Sustain a culture that promotes appropriate cancer-screening behaviors.

• To satisfy this requirement an organization must demonstrate that their company culture promotes and encourages appropriate cancer-prevention vaccines and cancer-screening tests and exams using whatever approaches work best within your organization (e.g. web, newsletters, brochures, seminars, videos, email reminders, etc.).
• Educating employees about the importance of being vaccinated and/or screened for particular cancers and about when to be vaccinated and/or screened for particular cancers is essential.

The suggestions are simply examples – they are not all required nor is it an all-inclusive list.

4b. Ensure that health benefit plans include cancer-screening provisions that adhere to the American Cancer Society (ACS) Guidelines or the US Preventive Services Task Force (USPSTF) Guidelines.

• This requirement is straightforward -- an organization must cover tests and cancer-screening procedures as recommended by either the ACS or the USPSTF.
• For each particular cancer, an organization may choose to exclusively follow ACS guidelines, exclusively follow USPSTF guidelines, or any combination of the two.
• Again, as with other requirements that involve health benefit plans, all enrolled employees and covered dependents must be included, and all plans (fully insured as well as self-insured) must be included.

4c. Offer health benefit plans that eliminate cost as a barrier to accessing preventive/screening tests and exams, including all vaccines approved by the FDA, and recommended by the CDC, for the prevention of cancer.

• Within the health benefit plans, an organization must remove cost as a barrier to having cancer-prevention vaccines and cancer-screening procedures done.
• Note that this does not mean “at no cost”.
• You may opt to eliminate co-pays, co-insurance or deductibles applicable to vaccines and screening procedures, although eliminating cost altogether is not required.
• What is required is that your health benefit plans must cover cancer-prevention vaccines and cancer-screening tests/exams at a cost-sharing level that is low enough (via sufficiently-low co-pays, co-insurance or deductibles) so that your participation rates are appropriate.
• An organization must demonstrate that cost is not a valid reason for an employee to not obtain appropriate cancer-prevention vaccines and cancer-screening tests and exams.
• Again, as with other requirements that involve health benefit plans, all enrolled employees and covered dependents must be included, and all plans (fully insured as well as self-insured) must pass the “cost is not a barrier” test.
• Coverage for all FDA-approved and CDC-recommended vaccines for the prevention of cancer must be in place by December 31, 2008.