Experimental. INVESTIGATIVE - the use of any treatment, Service, procedure, facility, equipment, drug, device or supply (intervention) which is not determined by the Plan to be medically effective for the condition being treated. The Plan will consider an intervention to be Experimental/Investigative if: a. the intervention does not have FDA approval to be marketed for the specific relevant indication(s); or b. available scientific evidence does not permit conclusions concerning the effect of the intervention on health outcomes; or c. the intervention is not proven to be as safe and as effective in achieving an outcome equal to or exceeding the outcome of alternative therapies; or d. the intervention does not improve health outcomes; or e. the intervention is not proven to be applicable outside the research setting. If an intervention as defined above is determined to be Experimental/Investigative at the time of Service, it will not receive retroactive coverage even if it is found to be in accordance with the above criteria at a later date.
Appears in 9 contracts
Samples: Individual Comprehensive Major Medical Preferred Provider Qualified High Deductible Health Plan Subscription Agreement, Individual Comprehensive Major Medical Exclusive Provider Subscription Agreement, Individual Comprehensive Major Medical Preferred Provider Subscription Agreement
