Plan Benefits and Rights Prescribed by Law

Approved Cancer Screenings

Some of the benefits provided through MCHCP for cancer screenings are listed below. These guidelines are based on the recommendations made by the American Cancer Society and may be age specific. Contact the American Cancer Society at 800-227-2345 for age specific guidelines.

  • Pelvic examination and pap smear for any woman without symptoms
  • Prostate examination and laboratory tests for any man without symptoms
  • Colorectal cancer examination and laboratory tests for any person without symptoms
  • Annual mammogram for any woman without symptoms

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

Clinical Cancer Trials

Missouri law requires coverage for routine patient care costs incurred as the result of a phase II, III or IV 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 includes reasonable and medically necessary services needed to administer the drug or use the device under evaluation in the clinical trial.

Scalp Hair Prosthesis

Missouri law requires coverage for members 18 years of age or younger with expenses for scalp hair prosthesis worn for hair loss suffered as a result of alopecia areata or alopecia totalis. There is a maximum benefit of $200 per calendar year, not to exceed a lifetime maximum benefit of $3,200 for persons who select a permanent form of 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 spent or the member reaches 19 years of age.

Right of Conversion - Available to HMO Plan members only

If your group policy is terminated, you may have the right to an individual converted policy without submission of a health statement. Contact Mercy Health Plans for additional information on individual policies.

Additional Information