47 Your Plan may require you to use an In-Network Provider to maximize your benefits. Routine patient care costs include items, services, and drugs provided to you in connection with an approved clinical trial that would otherwise be covered by this Plan. All requests for clinical trials services, including services that are not part of approved clinical trials will be reviewed according to our Clinical Coverage Guidelines, related policies and procedures. Your Plan is not required to provide benefits for the following services. The Plan reserves its right to exclude any of the following services: i. The Investigational item, device, or service; ii. Items and services that are given only to satisfy data collection and analysis needs and that are not used in the direct clinical management of the patient; iii. A service that is clearly inconsistent with widely accepted and established standards of care for a particular diagnosis; iv. Any item or service that is paid for, or should have been paid for, by the sponsor of the trial Dental Services Preparing the Mouth for Medical Treatments Your Plan includes coverage for dental services to prepare the mouth for medical services and treatments such as radiation therapy to treat cancer and prepare for transplants. Covered Services include: • Evaluation • Dental x-rays • Extractions, including surgical extractions • Anesthesia Treatment of Accidental Injury Benefits are also available for dental work needed to treat injuries to the jaw, sound natural teeth, mouth or face as a result of an accident. An injury that results from chewing or biting is not considered an Accidental Injury under this Plan, unless the chewing or biting results from a medical or mental condition. Anesthesia and Hospital Charges for Dental Care Your Plan covers anesthesia and Hospital charges for dental care, for a Member less than 19 years of age or a Member who is physically or mentally disabled, if the Member requires dental treatment to be given in a Hospital or Outpatient Ambulatory Surgery Center. The Indications for General Anesthesia, as published in the reference manual of the American Academy of Pediatric Dentistry, should be used to determine whether performing dental procedures is necessary to treat the Member’s condition under general anesthesia. This coverage does not apply to treatment for temporal mandibular joint disorders (TMJ). Diabetes Equipment, Education, and Supplies Benefits include all Physician prescribed Medically Necessary equipment and supplies used for the management and treatment of diabetes. Screenings for gestational diabetes are covered under “Preventive Care.”