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Pillar 2: Screening

Provide coverage for evidence-based cancer screening exams in ways that are age and gender appropriate, and that take into consideration individual risk/benefit – to detect certain cancers at an early stage, when management or treatment has the best chance for a positive outcome.

Ensure that covered employees and dependents have access to screening services for breast, colorectal, and cervical cancer at a reasonable cost-sharing level.

As with other CEO Cancer Gold Standard 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 and provide tests and cancer-screening procedures approved by the FDA, and recommended by the CDC, for breast, colorectal and cervical cancer screening at either no cost or at a reasonable cost-sharing level.

Important Note about Cancer Screening

Because routine, repeated exposure to testing carries its own risks, especially with technologies that use radiation, the U.S. Preventive Services Task Force (USPSTF) establishes guidelines for cancer screenings, including age ranges and testing frequencies.  Please refer to the USPSTF current recommendations for breast, cervical, and colorectal cancer screening.

Whether and when to screen for cancer should always be based on the individual’s health profile and family history, and in consultation with his or her personal physician.  This means certain employees or covered family members would need to be able to have cancer screenings before or after the stated age ranges, and more or less frequently than described in the USPSTF recommendations.

The expectation for Gold Standard employers is that employees and their eligible, covered dependents have access to breast, cervical, and colorectal cancer screenings a) at the appropriate times and intervals that fit their individual risk/benefit, in consultation with a physician and b) that are accessible at a reasonable cost-sharing level defined here as either at no cost or with a co-pay/co-insurance that is in line with coverage for other medical services under the terms of your plans.

Best Practices

Vidant Health

80% by 2018

Colorectal cancer is the second leading cause of cancer-related death among men and women combined, but it is also one of the most preventable types of cancer. Across Vidant Health's 29 county service area, screening rates are low. For a cancer that is preventable and treatable if found early through screening, 1 out of every 3 people in North Carolina are not getting the recommended screening. 

80% by 2018 is a national initiative with a goal of an 80% colorectal cancer...

Articles of Interest

Research & Evidence

Hannon, Peggy A., PhD, MPH; Jeffrey R. Harris, MD
American Journal of Preventive Medicine
Sauer, Ann Goding; Rebecca L. Siegel; Ahmedin Jemal; and Stacey A. Fedewa
American Association for Cancer Research

Frequently Asked Questions

Pillar 2: Screening

Which cancer screenings have to be covered in all health benefit plans?

An organization must cover tests and cancer-screening procedures approved by the FDA, and recommended by the CDC, for the prevention of cancer for breast, colorectal and cervical cancer.

Do all health benefit plans have to include coverage for cancer screening?

Yes, as with other CEO Cancer Gold Standard 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 and provide cancer screening at either no cost or at a reasonable cost-sharing level.