(4) for women, such additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration. charges made for surgical or non-surgical treatment of Temporomandibular Joint Dysfunction. charges made for hearing aids, including but not limited to semi-implantable hearing devices, audiant bone conductors and Bone Anchored Hearing Aids (BAHAs). A hearing aid is any device that amplifies sound. includes charges for the delivery of medical and health- related consultations via secure telecommunications technologies, including telephones and internet, when delivered through a contracted medical telehealth provider. Covered Expenses – Mental Health and Substance Use Disorder behavioral consultations and services via secure telecommunications technologies that shall include video capability, including telephones and internet, when delivered through a behavioral provider. Clinical Trials This benefit plan covers routine patient care costs related to a qualified clinical trial for an individual who meets the following requirements: (a) is eligible to participate in an approved clinical trial according to the trial protocol with respect to treatment of cancer or other life-threatening disease or condition; and (b) either the referring health care professional is a participating health care provider and has concluded that the individual’s participation in such trial would be appropriate based upon the individual meeting the conditions described in paragraph (a); or the individual provides medical and scientific information establishing that the individual’s participation in such trial would be appropriate based upon the individual meeting the conditions described in paragraph (a). For purposes of clinical trials, the term “life-threatening disease or condition” means any disease or condition from which the likelihood of death is probable unless the course of the disease or condition is interrupted. The clinical trial must meet the following requirements: The study or investigation must: be approved or funded by any of the agencies or entities authorized by federal law to conduct clinical trials; be conducted under an investigational new drug application reviewed by the Food and Drug Administration; or
involve a drug trial that is exempt from having such an investigational new drug application. Routine patient care costs are costs associated with the provision of health care items and services including drugs, items, devices and services otherwise covered by this benefit plan for an individual who is not enrolled in a clinical trial and, in addition: services required solely for the provision of the investigational drug, item, device or service; services required for the clinically appropriate monitoring of the investigational drug, device, item or service; services provided for the prevention of complications arising from the provision of the investigational drug, device, item or service; and reasonable and necessary care arising from the provision of the investigational drug, device, item or service, including the diagnosis or treatment of complications. Routine patient care costs do not include: the investigational drug, item, device, or service, itself; or items and services that are provided solely to satisfy data collection and analysis needs and that are not used in the direct clinical management of the patient. If your plan includes In-Network providers, clinical trials conducted by non-Participating Providers will be covered at the In-Network benefit level if: there are not In-Network providers participating in the clinical trial that are willing to accept the individual as a patient, or the clinical trial is conducted outside the individual’s state of residence. Genetic Testing Charges made for genetic testing that uses a proven testing method for the identification of genetically linked inheritable disease. Genetic testing is covered only if: a person has symptoms or signs of a genetically linked inheritable disease; it has been determined that a person is at risk for carrier status as supported by existing peer-reviewed, evidence- based, scientific literature for the development of a genetically linked inheritable disease when the results will impact clinical outcome; or the therapeutic purpose is to identify specific genetic mutation that has been demonstrated in the existing peer- reviewed, evidence-based, scientific literature to directly impact treatment options. Pre-implantation genetic testing, genetic diagnosis prior to embryo transfer, is covered when either parent has an
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