20. Dialysis: Charges for dialysis treatment of acute renal failure or chronic irreversible renal insufficiency for the removal of waste materials from the body, including hemodialysis and peritoneal dialysis. Coverage also includes use of equipment or supplies, unless covered through the Prescription Drug Benefits section. Charges are paid the same as for any other Illness. 21. Durable Medical Equipment, subject to all of the following: • The equipment must meet the definition of Durable Medical Equipment in the Glossary of Terms. Examples include, but are not limited to, crutches, wheelchairs, Hospital-type beds, and oxygen equipment. • The equipment must be prescribed by a Physician. • The equipment will be provided on a rental basis when available; however, such equipment may be purchased at the Plan's option. Any amount paid to rent the equipment will be applied toward the purchase price. In no case will the rental cost of Durable Medical Equipment exceed the purchase price of the item. • The Plan will pay benefits for only ONE of the following: a manual wheelchair, motorized wheelchair or motorized scooter, unless necessary due to the growth of the person or if changes to the person's medical condition require a different product, as determined by the Plan. • If the equipment is purchased, benefits may be payable for subsequent repairs excluding batteries, or replacement only if required: ➢ due to the growth or development of a Dependent Child; ➢ because of a change in the Covered Person’s physical condition; or ➢ because of deterioration caused from normal wear and tear. The repair or replacement must also be recommended by the attending Physician. In all cases, repairs or replacement due to abuse or misuse, as determined by the Plan, are not covered, and replacement is subject to prior approval by the Plan. • This Plan covers taxes and shipping and handling charges for Durable Medical Equipment. 22. Emergency Room Hospital and Physician Services, including Emergency room services for stabilization or initiation of treatment of a medical Emergency condition provided on an Outpatient basis at a Hospital, as shown in the Schedule of Benefits. 23. Extended Care Facility Services for both mental and physical health diagnoses. Charges will be paid under the applicable diagnostic code. The following services are covered: • Room and board. • Miscellaneous services, supplies, and treatments provided by an Extended Care Facility, including Inpatient rehabilitation. 24. Eye Refractions if related to a covered medical condition. 25. Foot Care (Podiatry) that is recommended by a Physician as a result of infection. The following charges for foot care will also be covered: • Treatment of any condition resulting from weak, strained, flat, unstable, or unbalanced feet when surgery is performed. • Treatment of corns, calluses, and toenails when at least part of the nail root is removed or when needed to treat a metabolic or peripheral vascular disease. • Physician office visit for diagnosis of bunions. The Plan also covers treatment of bunions when an open cutting operation or arthroscopy is performed. -59- 7670-00-413597