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BRCA Testing

BRCA testing without cost-share effective Oct, 1, 2013
The Department of Health and Human Services (HHS) requires both genetic counseling and BRCA 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 USPSTF issued a draft recommendation in April 2013 that would give 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 (CDG) currently covers screening and counseling and will cover the BRCA test for some women starting Oct. 1, 2013. The BRCA test as well as screening and counseling will be 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.

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