65 Routine Immunizations The following charges for routine immunizations are covered medical benefits under the terms of the Plan. • Charges for an annual flu shot. • Charges for other medically appropriate routine childhood and adult immunizations when recommended or provided by a physician, excluding immunizations solely for travel. Routine Lab and X-ray Screening The following charges for routine lab and X-ray screening are covered medical benefits under the terms of the Plan. • Charges for routine laboratory, electrocardiogram, and x-ray screening services ordered or performed by a physician in connection with a covered routine examination or wellness program. • Charges for an annual Papanicolaou (PAP) screening for female participants. • Charges for an annual prostate specific antigen (PSA) screening for male participants. Routine Colonoscopy Screening This benefit applies to all covered individuals once every three (3) years beginning at age 50 or, if there is a high risk of colon cancer indicated by a physician, once every two (2) years regardless of age. The following charges for routine colonoscopy screening are covered medical benefits under the terms of the Plan. • Charges for a surgeon and an anesthesiologist who perform the procedure. • Charges for outpatient facility use at a Hospital or other approved surgical facility. • Charges for related professional interpretation services required as a result of surgery. Removal of polyps that are found during the routine screening are included. Routine Mammography Screening Charges for routine screening for breast cancer by low-dose mammography that are listed below are covered medical charges if ordered by a physician. Mammography screening charges include only: • Charges for a baseline mammogram for a covered individual age 35 but less than age 40. • Charges for a mammogram performed once every year for a covered individual age 40 and over. The term low-dose mammography means the x-ray examination of the breast using equipment dedicated specifically for mammography, including, but not limited to, the x-ray tube, filter, compression device, screens, films and cassettes, with an average radiation exposure delivery of less than one rad mid-breast, with two views for each breast.