Chemotherapy See “Therapy Services.” Chronic Pain Benefits are based on the setting in which Covered Services are received. Management Services Clinical Trials Benefits are based on the setting in which Covered Services are received. Dental Services Benefits are based on the setting in which Covered Services are received. (Limited to services for accidental injury, or to prepare the mouth for certain medical treatments) Diabetes Equipment, Education, and Supplies Screenings for gestational diabetes are covered under “Preventive Care.” Benefits for diabetic 20% Coinsurance after 40% Coinsurance after 50% Coinsurance after education are based on Deductible Deductible Deductible the setting in which Covered Services are received. Diagnostic Services • Reference Labs No Copayment, No Copayment, 50% Coinsurance after Deductible, or Deductible, or Deductible Coinsurance Coinsurance • All Other Benefits are based on the setting in which Covered Services are received Diagnostic Services Dialysis See “Therapy Services.” Durable Medical Equipment (DME), Medical Devices, and Supplies 17