46 Prosthetic Limbs & Orthotic Custom Fabricated Brace or Support Prosthetic limbs (artificial leg or arm) and a Medically Necessary orthotic c ustom fabricated brace or support designed as a component of a prosthetic limb, including repairs or replacements, will be covered if: • Determined by your Physician to be Medically Necessary to restore or maintain your ability to perform activities of daily living or essential job related activities; and • Not solely for comfort or convenience. Coverage for Prosthetic limbs and orthotic devices under this provision m ust be equal to the coverage that is provided for the same device, repair, or replacement under the federal Medicare program. Reimbursement must be equal to the reimbursement that is provided for the same device, repair, or replacement under the federal M edicare reimbursement schedule, unless a different reimbursement rate is negotiated. Prosthetic limbs and Orthotic c ustom fabricated braces or supports designed as components for a prosthetic limb are covered the same as any other Medically Necessary items and services and will be subject to the same annual Deductible, Coinsurance, Copayment as other Covered Services under your Plan. Medical and Surgical Supplies Your Plan includes coverage for medical and surgical supplies that serve only a medical purpose, are used once, and are purchased (not rented). Covered supplies include syringes, needles, surgical dressings, splints, and other similar items that serve only a medical purpose. Covered Services do not include items often stocked in the home for general use like Band - Aids, thermometers, and petroleum jelly. Medical food that is Medically Necessary and prescribed by a Physician for the treatment of an inherited metabolic disease is covered. Medical foods mean a formula that is intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation and formulated to be consumed or administered enterally under the direction of a Physician. Blood and Blood Products Your Plan also includes coverage for the administration of blood products. Emergency Care Services If you are experiencing an Emergency please call 911 or visit the nearest Hospital for treatment. If you are experiencing a mental health crisis, you may also call 988 for assistance. Emergency Services Benefits are available in a Hospital Emergency Room or freestanding Emergency Facility for services and supplies to treat the onset of symptoms for an Emergency, which is defined below. Emergency (Emergency Medical Condition) “Emergency” or “Emergency Medical Condition” means a n accidental traumatic bodily injury or other medical or behavioral health condition that arises suddenly and unexpectedly and manifests itself by acute symptoms of such severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent lay person who possesses an average k nowledge of health and medicine to: (a) place an individual's health or the health of another person in serious jeopardy; (b) resu lt