46 Dialysis See “Therapy Services” later in this section. Durable Medical Equipment (DME), Medical Devices, and Supplies Your Plan includes benefits for durable medical equipment and medical devices when the equipment meets the following criteria: • Is meant for repeated use and is not disposable. • Is used for a medical purpose and is of no further use when medical need ends. • Is meant for use outside a medical Facility. • Is only for the use of the patient. • Is made to serve a medical use. • Is ordered by a Provider. Benefits include purchase - only equipment and devices (e.g., crutches and customized equipment), purchase or rent - to - purchase equipment and devices (e.g., Hospital beds and wheelchairs), and continuous rental equipment and devices (e.g., oxygen concentrator , ventilator, and negative pressure wound therapy devices). Continuous rental equipment must be approved by us. The Plan may limit the amount of coverage for ongoing rental of equipment. The Plan may not cover more in rental costs than the cost of simply purchasing the equipment. Benefits include repair and replacement costs as well as supplies and equipment needed for the use of the equipment or device, for example, a battery for a powered wheelchair. Oxygen and equipment for its administration are also Covered Services. Orthotics Benefits are available for certain types of orthotics (braces, boots, splints). Covered Services include the initial purchase, fitting, and repair of a custom made rigid or semi - rigid supportive device used to support, align, prevent, or correct deformities or to improve the function of movable parts of the body, or which limits or st ops motion of a weak or diseased body part. Orthotic appliances may be replaced once per year per Member when Medically Necessary in the Member’s situation. However, additional replacements will be allowed for Members under age 18 due to rapid growth, or for any Member when an appliance is damaged and cannot be repaired. Coverage for an orthotic c ustom fabricated brace or support designed as a component for a prosthetic limb is described in more detail below. Prosthetics Your Plan also includes benefits for prosthetics, which are artificial substitutes for body parts for functional or therapeutic purposes, when they are Medically Necessary for activities of daily living. Benefits include the purchase, fitting, adjustments, repairs and replacements. Covered Services may include, but are not limited to: • Artificial limbs and accessories. Coverage for a prosthetic limb (artificial leg or arm) is described in more detail below.
Benefit Booklet: Plan 1 Page 46 Page 48