| Health Screening Benefit |
| Benefit Amount: $50 |
| Payable if an eligible covered person takes one of the screening/prevention measures listed below. Times Payable per Calendar Year: 1 time per Employee, 1 time per Spouse/Domestic Partner, 1 time per Dependent Child. Eligible Screening / Prevention Measures: |
| |
| Routine Health Check-Up Exam |
| Biopsies For Cancer |
| Blood Chemistry Panel |
| Blood Test To Determine Total Cholesterol |
| Blood Test To Determine Triglycerides |
| Bone Marrow Testing |
| Breast MRI |
| Breast Ultrasound |
| Breast Sonogram |
| Cancer Antigen 15-3 Blood Test For Breast Cancer (CA 15-3) |
| Cancer Antigen 125 Blood Test For Ovarian Cancer (CA 125) |
| Carcinoembryonic Antigen Blood Test For Colon Cancer (CEA) |
| Carotid Doppler |
| Chest X-Rays |
| Clinical Testicular Exam |
| Colonoscopy |
| Complete Blood Count (CBC) |
| Coronavirus Testing Skin Exam |
| Dental Exam |
| Digital Rectal Exam (DRE) |
| Doppler Screening For Cancer |
| Doppler Screening For Peripheral Vascular Disease |
| Echocardiogram |
| Electrocardiogram (EKG) |
| Electroencephalogram (EEG) |
| Endoscopy |
| Fasting Plasma Glucose Test |
| Fasting Blood Glucose Test |
| Flexible Sigmoidoscopy |
| Hearing Test |
| Hemoccult Stool Specimen |
| Hemoglobin A1c |
| Human Papillomavirus (HPV) Vaccination |
| Immunizations |
| Lipid Panel |
| Mammogram |
| Oral Cancer Screening |
| PAP Smears Or Thin Prep PAP Test |
| Prostate-Specific Antigen (PSA) Test |
| Serum Cholesterol Test To Determine Ldl And Hdl Levels |
| Serum Protein Electrophoresis |
| Skin Cancer Biopsy |
| Skin Cancer Screening |
| Stress Test On Bicycle Or Treadmill |
| Successful Completion Of Smoking Cessation Program |
| Tests For Sexually Transmitted Infections (STI's) |
| Thermography |
| Two-Hour Post-Load Plasma Glucose Test |
| Ultrasounds For Cancer Detection |
| Ultrasound Screening Of The Abdominal Aorta For Abdominal Aortic Aneurysms |
| Virtual Colonoscopy |
