Common use of Breast Cancer Clause in Contracts

Breast Cancer. Benefits for Covered Services in relation to Breast Cancer are provided, including, screening and diagnosis of breast cancer, consistent with generally accepted medical practice and scientific evidence. Treatment for breast cancer includes coverage for prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. See “Prosthetics and Devices,” as well as “Inpatient Facility Services,” and “Preventive Services” for additional details. Cardiac Rehabilitation Therapy Please see “Therapy Services” later in this section. Chemotherapy Please see “Therapy Services” later in this section. Child Dental Services Please see “Dental Services” later in this section. Child Vision Services Please see “Vision Services” later in this section. Clinical Trials Benefits include coverage for services given to You as a participant in an approved Clinical Trial if the services are Covered Services under this Plan, including routine patient care costs. Routine patient care costs include the costs associated with the provision of health care services, including drugs, items, devices, and services that would otherwise be covered under the plan or contract if those drugs, items, devices, and services were not provided in connection with an approved clinical trial program, including: • Health care services typically provided absent a clinical trial. • Health care services required solely for the provision of the investigational drug, item, device, or service. • Health care services provided for the prevention of complications arising from the provision of the investigational drug, item, device, or service. • Health care services needed for the reasonable and necessary care arising from the provision of the investigational drug, item, device, or service, including the diagnosis or treatment of the complications. Routine patient care costs do not include the costs associated with the provision of any of the following: • Drugs or devices that have not been approved by the federal Food and Drug Administration and that are associated with the clinical trial. • Services other than health care services, such as travel, housing, companion expenses, and other nonclinical expenses, that an Enrollee may require as a result of the treatment being provided for purposes of the clinical trial. • Any item or service that is provided solely to satisfy data collection and analysis needs and that is not used in the clinical management of the patient. • Health care services that, except for the fact that they are being provided in a clinical trial, are otherwise specifically excluded from coverage under the Plan. • Health care services customarily provided by the research sponsors free of charge for any enrollee in the trial. Eligibility to participate in the clinical trial will be determined according to the trial protocol with respect to treatment of cancer or other life-threatening condition (a condition from which the likelihood of death is probable unless the course of the condition is interrupted), as determined in one of the following ways: (i) determination is made by Xxxxx; (ii) Enrollee provides Oscar with medical and scientific information establishing this determination. If any In-Network providers participate in the clinical trial and will accept the enrollee as a participant in the clinical trial, the enrollee must participate in the clinical trial through an In-Network provider unless the clinical trial is outside the state where the enrollee lives; or the clinical trial is an approved clinical trial, meaning it is a phase I, phase II, phase III, or phase IV clinical trial related to the prevention, detection, or treatment of cancer or other life-threatening condition and it meets one of the following requirements: