In most cases, the WTC Health Program will cover diagnostic services for the conditions it treats, from GERD to cancers. In the case of cancer, however, certain high-risk populations who require regular screenings. Because of this, the program has a few policies in place to make sure these screenings are available to people who meet certain age and risk-factor criteria.
The program allows a range of diagnostic services including blood work, imaging studies, biopsies, and specialty consults - the kinds of things your Program doctor would need to determine if you have a cancer that is covered by the Program. Here are their policies on some of the more commonly diagnosed cancers:
Breast Cancer:
Screening is available to women age 50-74 once every other year
More frequent screening may be covered for people who have a higher risk, such as family history or a previous diagnosis
If a mammogram receives a positive result, an additional mammogram is allowed
Colon Cancer:
Available to members age 45-75
Earlier or more frequent screenings may be permitted for patients with higher risk
Cervical Cancer:
Available to most female members age 21-65, who may receive a Pap smear every three years
Female members between 30 and 65 may receive a Pap smear every three years or a Pap smear in combination with HPV testing every five years.
Earlier or more frequent screenings may be permitted for patients with higher risk
Lung Cancer Screening:
Annual lung cancer screening is available to eligible members aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. A pack year is the equivalent of smoking an average of 20 cigarettes, or one full pack, per day for a year.
More information is available at the program’s Cancer Factsheet.