State and Federally Mandated Benefits

MCHCP medical plans comply with state and federally mandated benefits.

Approved Cancer Screenings

Some of the benefits provided through MCHCP for cancer screenings are listed below. The following guidelines are based on the recommendations made by the American Cancer Society and may be age specific. (Contact the American Cancer Society for age specific guidelines.)

• Pelvic examination and pap smear for any nonsymptomatic woman.
• Prostate examination and laboratory tests for any nonsymptomatic man.
• Colorectal cancer examination and laboratory tests for any nonsymptomatic person.
• Annual mammogram for any nonsymptomatic woman.

Additional mammograms are covered for women if recommended by a physician, or for any woman whose mother or sister has prior history of breast cancer.

Scalp Hair Prosthesis

Missouri law requires coverage for members 18 years of age or younger for expenses for scalp hair prosthesis worn for hair loss suffered as a result of alopecia areata or alopecia totalis. The coverage shall have a maximum benefit of $200/calendar year, not to exceed a lifetime maximum benefit of $3,200 for persons who select a more permanent scalp hair prosthesis. A one-time expenditure of up to $3,200 may be requested, and benefits expire when a total of $3,200 has been expended or the member reaches 19 years of age.

Clinical Cancer Trials

Missouri law requires coverage for routine patient care costs incurred as the result of phase III or IV of a clinical trial that is approved by an appropriate entity and is undertaken for the purposes of the prevention, early detection, or treatment of cancer. Coverage includes routine patient care costs incurred for drugs and devices that have been approved for sale by the Food and Drug Administration (FDA), regardless of whether approved by the FDA for use in treating the patient’s particular condition. Coverage also includes reasonable and medically necessary services needed to administer the drug or use the device under evaluation in the clinical trial.

Women's Health Law

Missouri law requires:

• Direct access to a network obstetrician, gynecologist or OB/GYN for obstetrical or gynecological diagnosis, treatment or referral.
• Coverage for the diagnosis, treatment, and appropriate management of osteoporosis, which may include bone mass measurement when medically indicated.
• Coverage for all prescription drugs and devices approved by the FDA for use as a contraceptive.

This law removes any timeframe on reconstructive surgery or prosthetic devices following a mastectomy. If an individual had a mastectomy and changes health plans, the new plan shall provide coverage consistent with the federal Women’s Health and Cancer Rights Act.

Newborn Screenings

Missouri law requires coverage for:

• Newborn hearing screenings.
• Necessary rescreenings.
• Audiological assessment.
• Follow-up and initial amplification.

Dental Care: Anesthesia & Hospital Charges

Missouri law requires health insurers and similar entities to cover the administration of general anesthesia and hospital charges for dental care to children under age five, the severely disabled, or a person with a medical or behavioral condition that requires hospitalization. It mandates coverage of general anesthesia when dental care is provided in a participating or non-participating hospital or surgical center. Prior authorization may be required by the health carrier.