Cancer definitionOn May 18th, the United States Preventive Services Task Force added a new recommendation regarding colonoscopies. The current guidance recommends colorectal cancer screenings for adults aged 50 to 75 years (“A” designation), while the new recommendation extends screenings to persons ages 45–49 (“B” designation). Under the Affordable Care Act, non-grandfathered health plans will be required to cover in-network routine colonoscopies at 100% for those 45-49 years old.
These recommendations become effective on the first plan year following one year from the publish date, so implementation won’t be required until May 2022 at the earliest. However, employers are welcome to implement the new recommendation earlier if they so choose. Additionally, plans may want to consider removing any age limitation on this service. Several MedBen clients have already made this request, as this is not a benefit which is abused.
The MedBen Compliance team will provide more detailed information about the new guidelines as the implementation date approaches. In the meantime, you are welcome to contact Director of Compliance and Medical Management Erin Kelly at if you have any questions.