BRCA Testing without Cost-Share
The Department of Health and Human Services (HHS) requires both genetic counseling and BRCA (Breast Cancer Gene) testing, if appropriate, for a woman should be covered as a preventive service and without cost-share by non-grand fathered plans.
A woman's risk of breast or ovarian cancer is greatly increased if she inherits a BRCA gene mutation. The United States Preventive Services Task Force issued a draft recommendation in April 2013 that gave a "B" rating to screening women who have family members with breast or ovarian cancer. The screening identifies a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2). UnitedHealthcare provides coverage at no cost-share, under most plans, for genetic counseling to women with a family history, and if appropriate following counseling, BRCA testing. Some grand fathered plans may continue to apply cost-share to these services.
UnitedHealthcare's Preventive Care Services Coverage Determination Guideline covers screening and counseling and the BRCA test for some women. The BRCA test as well as screening and counseling is covered without cost-share by most plans for women age 18 years of age and older with a family history of ovarian and/or breast cancer and who do not have a personal history or current diagnosis of ovarian and/or breast cancer.
Prior authorization requirements continue to apply. Effective January 1, 2016 genetic counseling by a qualified provider to review the hereditary history and to discuss the impact of the test on treatment is required prior to testing. The provider qualifications are listed in the policy link below. Genetic counselors can be located using our provider directory.