Part 5 – Covered Services (continued) IMPORTANT: Refer to the Schedule of Benefits for your plan option for the cost share amounts that you must pay for covered services and for the benefit limits that may apply to specific covered services. Once you reach your benefit limit for a specific covered service, no more benefits are provided by Blue Cross Blue Shield HMO Blue for those services or supplies. WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 64  Augmentative communication devices. An “augmentative communication device” is one that assists in restoring speech. It is needed when a member is unable to communicate due to an accident, illness, or disease such as amyotrophic lateral sclerosis (ALS). If you are enrolled in this health plan and it does not include pharmacy coverage, this coverage for prosthetic devices is also provided for: insulin infusion pumps and related pump supplies; and materials to test for the presence of sugar when they are ordered for you by a physician for home use. These testing materials are: blood glucose monitoring strips; ketone strips; lancets; urine glucose testing strips; normal, low, and high calibrator solution/chips; and dextrostik or glucose test strips. This health plan covers the most appropriate medically necessary model that meets your medical needs. This means that if Blue Cross Blue Shield HMO Blue determines that you chose a model that costs more than what you need for your medical condition, benefits will be provided only for those charges that would have been paid for the most appropriate medically necessary model that meets your medical needs. In this case, you must pay all of the provider’s charges that are more than the Blue Cross Blue Shield HMO Blue claim payment. Qualified Clinical Trials for Treatment of Cancer This health plan covers health care services and supplies that are received by a member as part of a qualified clinical trial (for treatment of cancer) when the member is enrolled in that trial. This coverage is provided for health care services and supplies that are consistent with the study protocol and with the standard of care for someone with the patient’s diagnosis, and that would be covered if the patient did not participate in the trial. This coverage may also be provided for investigational drugs and devices that have been approved for use as part of the trial. This health plan coverage for health care services and supplies that you receive as part of a qualified clinical trial is provided to the same extent as it would have been provided if you did not participate in a trial. No benefits are provided for:  Investigational drugs and devices that have not been approved for use in the trial.  Investigational drugs and devices that are paid for by the manufacturer, distributor, or provider of the drug or device, whether or not the drug or device has been approved for use in the trial.  Non-covered services under your health plan.  Costs associated with managing the research for the trial.  Items, services, or costs that are reimbursed or otherwise furnished by the sponsor of the trial.  Costs that are inconsistent with widely accepted and established national and regional standards of care.  Costs for clinical trials that are not “qualified trials” as defined by law. Other Approved Clinical Trials In addition to clinical trials for cancer, this health plan covers a member who participates in an approved clinical trial for a life-threatening disease or condition, as required by federal law. This means a disease or condition from which death is likely unless the course of the disease is interrupted. This coverage is