We’re pleased to share that effective for dates of service on or after July 1, 2026, specialized risk screening for eligible first responders will be covered for Harvard Pilgrim Health Care members whose treating providers have determined that the screening is medically appropriate and has meaningful potential for preventive clinical benefit. 

In support of Maine LD 784, the following health screening tests will be covered for Maine first responders.

  • Tests for evidence of any cancer with a known employment-related risk of exposure 
  • Blood tests, including complete blood count, comprehensive metabolic panel, renal panel, and hepatic panel
  • Mammography, colonoscopy, or prostate examination regardless of the age of the person
  • Tests of any measure of serum activity of lipoprotein-associated phospholipase enzyme A2, oxidized low-density lipoprotein, or additional indicators of endovascular inflammation
  • Tests to measure vitamin deficiencies, nutritional deficits, and mineral levels

The state of Maine defines first responders as employees or occasional employees of a state, county, or municipal government entity, or volunteers of a state, county, or municipal government entity, that provides or has the authority to provide fire, emergency medical, emergency communications, correctional, or police services. 

If you provide care for a Harvard Pilgrim Health Care member who is a Maine first responder for whom specialized risk screening coverage has been denied, you can choose to file an appeal on their behalf. When submitting your appeal, please clearly and prominently indicate — on the appeal request and in all supporting documentation — that the patient is a Maine first responder. This will allow for proper routing of your appeal for consideration. For assistance with submitting an appeal, refer to Point32Health’s Guide to navigating pre-service clinical appeals.