Network
20% coinsurance after deductible
Non-Network
40% coinsurance after deductible
Network
20% coinsurance after deductible
Non-Network
40% coinsurance after deductible
Network
20% coinsurance after deductible
Non-Network
40% coinsurance after deductible
Coverage, as required by Missouri law, for routine patient care costs incurred as the result of a Phase I, II, III, or IV clinical trial that is conducted in relation to the prevention, detection, or treatment of cancer or other life-threatening disease or condition. The study or investigation is conducted under an investigational new drug application reviewed by the Food and Drug Administration or is a drug trial that is exempt from having such an investigational new drug application. Life-threatening condition means any disease or condition from which the likelihood of death is probable unless the course of the disease or condition is interrupted. Routine patient care costs include all items and services consistent with the coverage provided in Plan benefits and would otherwise be covered for a member that is not enrolled in a clinical trial. Routine patient care costs do no not include the investigational item, device or service itself; items and services that are provided solely to satisfy data collection and analysis needs and are not used in the direct clinical management of the member; or a service that is clearly inconsistent with widely accepted and established standards of care for a particular diagnosis. The member must be eligible to participate in the clinical trial according to the trial protocol with respect to treatment of cancer or other life-threatening disease or condition. The clinical trial must be approved or funded by one of the following:
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