Clinical Trials
Benefits are available for routine patient care costs incurred during participation in a qualifying clinical trial for the treatment of:
  • Cancer or other life-threatening disease or condition. For purposes of this benefit, a life-threatening disease or condition is one from which the likelihood of death is probable unless the course of the disease or condition is interrupted
  • Cardiovascular disease (cardiac/stroke) which is not life threatening for which, as determined by UnitedHealthcare, a clinical trial meets the qualifying clinical trial criteria
  • Surgical musculoskeletal disorders of the spine, hip and knees, which are not life threatening, for which UnitedHealthcare determines a clinical trial meets the qualifying clinical trial criteria
  • Other disease or disorders which are not life threatening for which, UnitedHealthcare determines, a clinical trial meets the qualifying clinical trial criteria
Benefits include the reasonable and necessary items and services used to prevent, diagnose and treat complications arising from participation in a qualifying clinical trial.
Benefits are available only when the covered member is clinically eligible for participation in the qualifying clinical trial as defined by the researchers.
Routine patient care costs for qualifying clinical trials include:
  • Covered health services for which benefits are typically provided absent a clinical trial
  • Covered health services required solely for the provision of the investigational item or service, that clinically appropriately monitoring of the effects of the item or service, or the prevention of the complications
  • Covered health services needed for reasonable and necessary care arising from the provision of the investigational item or service
Prior Authorization Requirement
For out-of-network benefits, you must obtain prior authorization from UnitedHealthcare as soon as the possibility of participation in a clinical trial arises. If you fail to obtain prior authorization as required, eligible benefits will be subject to a $400 penalty.