2026 CODAC Benefit Summaries and Carrier Flyers

➢ The Department of Veterans Affairs, the DOD , or the Department of Energy as long as the study or investigation has been reviewed and approved through a system of peer review that is determined by the Secretary of Health and Human Services to meet both of the following criteria: − It is comparable to the system of peer review of studies and investigations used by the NIH; and − It ensures unbiased review of the highest scientific standards by qualified individuals who have no interest in the outcome of the review. • The study or investigation is conducted under an Investigational new drug application reviewed by the U.S. Food and Drug Administration; • The study or investigation is a drug trial that is exempt from having such an Investigational new drug application; • The clinical trial must have a written protocol that describes a scientifically sound study and have been approved by all relevant Institutional Review Boards ( IRBs ) before participants are enrolled in the trial. The Plan Sponsor may, at any time, request documentation about the trial; or • The subject or purpose of the trial must be the evaluation of an item or service that meets the definition of a covered health service and is not otherwise excluded under the Plan.

62. Radiation Therapy and Chemotherapy when Medically Necessary.

63.

Radiology and Interpretation Charges.

64.

Reconstructive Surgery includes:

• Surgery following a mastectomy under the Women’s Health and Cancer Rights Act (WHCRA). Under the WHCRA, the Covered Person must be receiving benefits in connection with a mastectomy in order to receive benefits for reconstructive treatments. Covered Expenses are reconstructive treatments that include all stages of reconstruction of the breast on which the mastectomy was performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; and prostheses and complications of mastectomies, including lymphedemas. • Surgery to restore a bodily function that has been impaired by a congenital Illness or anomaly, or by an Accident, or from an infection or other disease of the involved part.

65.

Respiratory Therapy. (See Therapy Services below.)

66. Second Surgical Opinion if given by a board-certified Specialist in the medical field related to the surgical procedure being proposed. The Physician providing the second opinion must not be affiliated in any way with the Physician who rendered the first opinion.

67.

Sleep Disorders if Medically Necessary.

68. Sleep Studies. Home unattended sleep studies are not covered.

69.

Speech Therapy. (See Therapy Services below.)

70.

Sterilizations.

71. Substance Use Disorder Services. (Refer to the Behavioral Health Benefits section of this SPD.)

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