GCIFM-7261 Wellness Benefit Reimbursement 2 of 4 04/23 4 | Wellness /Cancer screening information Please check off the appropriate box that best describes the screening test completed. Annual physical examination Abdominal and aortic aneurysm ultrasonography Biopsy for cancer Bone density screening Bone marrow testing Breast Cancer Screening (clinical breast exam, mammography*, MRI, thermography, ultrasound, cervical cancer screening BRCA testing CA 15-3 (blood test for breast cancer) CA 125 (blood test for ovarian cancer) Cardiac Exercise Stress Test Carotid Doppler CEA (blood test for colon cancer) Chest x-ray Colorectal Cancer Screening (fecal occult blood test, colonoscopy, sigmoidoscopy) CT angiography CT scans or MRI scans Dental examination Diabetes tests (fasting blood glucose test, hemoglobin A1c) Double contrast barium enema Echocardiogram Electrocardiogram (ECG) - resting or stress Gynecological exam (PA only) Hemocult Stool Analysis Immunizations (includes flu shots) Interscholastic Sports Physical Exam Lipid panel (cholesterol, triglycerides, HDL, LDL) Lymphocyte genome sensitivity test (LGS) (universal blood test for cancer) Pap smear (including ThinPrep) Prostate Cancer Screening (digital rectal exam, PSA blood test) Serum Protein Electrophoresis (blood test for myeloma) Skin Cancer Screening Smoking cessation program Testicular ultrasound Vision examination Weight reduction program *For TN, see policy for mammography benefit