2024 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 52
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 52
Benefit Description
Durable Medical Equipment (DME) (cont.)
Note: We cover DME at Preferred benefit levels only when you use a Preferred DME provider. Preferred physicians, facilities, and pharmacies are not necessarily Preferred DME providers.
*Prior approval required
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Durable Medical Equipment (DME) (cont.)
- Crutches
- Walkers
- Continuous passive motion (CPM) devices
- Dynamic orthotic cranioplasty (DOC) devices
- Insulin pumps
- Other items that we determine to be DME, such as compression stockings
- Specialty DME* to include:
- Specialty hospital beds
- Deluxe wheelchairs, power wheelchairs and mobility devices including scooters and related supplies.
- Specialty hospital beds
Note: We cover DME at Preferred benefit levels only when you use a Preferred DME provider. Preferred physicians, facilities, and pharmacies are not necessarily Preferred DME providers.
*Prior approval required
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Benefit Description
You Pay
Any amount over $625 per year (no deductible)
- Speech-generating devices, limited to $625 per calendar year
You Pay
Any amount over $625 per year (no deductible)
Benefit Description
Not covered:
You Pay
All charges
Not covered:
- Exercise and bathroom equipment
- Vehicle modifications, replacements, or upgrades
- Home modifications, upgrades, or additions
- Lifts, such as seat, chair, or van lifts
- Car seats
- Diabetic supplies, except as described in Section 5(f) or when Medicare Part B is primary
- Air conditioners, humidifiers, dehumidifiers, and purifiers
- Breast pumps, except as previously described
- Communications equipment, devices, and aids (including computer equipment) such as “story boards” or other communication aids to assist communication-impaired individuals (except for speech-generating devices as listed above)
- Equipment for cosmetic purposes
- Topical Hyperbaric Oxygen Therapy (THBO)
- Charges associated with separate or extended warranties
You Pay
All charges
Benefit Description
Medical Supplies
Covered medical supplies include:
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Medical Supplies
Covered medical supplies include:
- Medical foods and nutritional supplements when administered by catheter or nasogastric tubes
Note: See Section 10 for the definition of medical foods.
- Ostomy and catheter supplies
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges