If no referral is received, no benefits are payable. Prior Authorization is required for oral contraceptives and growth hormones. Please submit these claims directly to Chickering Claims Administrators Inc. for reimbursement. The Plan will cover one baseline mammogram for women between the ages of 35 to 40. Women age 40 and over have coverage for on mammogram per Policy Year therafter.
Benefits are payable on the same basis as any x-ray expense.