15 Benefits In-Network Out-of-Network Cellular and Gene Therapy Services Precertification required See the “Human Organ and Tissue Transplant (Bone Marrow / Stem Cell), Cellular and Gene Therapy Services” section later in this Schedule. Chemotherapy See “Therapy Services.” Chronic Pain Management Services Benefits are based on the setting in which Covered Services are received. Clinical Trials Benefits are based on the setting in which Covered Services are received. Dental Services (Limited to services for accidental injury, or to prepare the mouth for certain medical treatments) Benefits are based on the setting in which Covered Services are received. Diabetes Equipment, Education, and Supplies Screenings for gestational diabetes are covered under “Preventive Care.” 20% Coinsurance after Deductible 40% Coinsurance after Deductible Benefits for diabetic education are based on the setting in which Covered Services are received. Diagnostic Services • Reference Labs 0% Coinsurance after Deductible 50% Coinsurance after Deductible • All Other Diagnostic Services Benefits are based on the setting in which Covered Services are received. Dialysis See “Therapy Services.” Durable Medical Equipment (DME), Medical Devices, and Supplies • Durable Medical Equipment (DME) and Medical Devices 20% Coinsurance after Deductible 40% Coinsurance after Deductible