Diabetes Services. Diabetes Self-Management and Training and Education Services Diabetic Self-Management Supplies
Diabetes Services. Unless otherwise covered under a Prescription Drug Rider or Policy, coverage is included for drugs, including insulin, equipment, agents, and Orthotics used for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and non-insulin-using diabetes when prescribed by a health care professional legally authorized to prescribe such items and are mandated by law. Equipment, agents, and Orthotics shall include:
1. injectable aids (e.g., syringes)
2. pharmacological agents for controlling blood sugar 3. blood glucose monitors and related supplies 4. injection insulin infusion devices
Diabetes Services. This benefit has one or more exclusions as specified in the Exclusions Section. Coverage for individuals with diabetes may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate, as long as the annual deductibles or coinsurance for benefits are no greater than the annual deductibles or coinsurance established for similar benefits within a given policy. Covered Benefits are provided if you have insulin dependent (Type I) diabetes, non-insulin dependent (Type 2) diabetes, and elevated blood glucose levels induced by pregnancy (gestational diabetes). We will guarantee Coverage for the equipment, appliances, Prescription Drug/Medications, insulin or supplies that meet the United States Food and Drug Administration (FDA) approval, and are the medically accepted standards for diabetes treatment, supplies and education.
Diabetes Services. This benefit has one or more exclusions as specified in the Exclusions Section. Covered Benefits are provided if you have insulin dependent (Type I) diabetes, non-insulin dependent (Type 2) diabetes, and elevated blood glucose levels induced by pregnancy (gestational diabetes). We will guarantee Coverage for the equipment, appliances, Prescription Drug/Medications, insulin or supplies that meet the United States Food and Drug Administration (FDA) approval, and are the medically accepted standards for diabetes treatment, supplies and education.
Diabetes Services. This benefit has one or more exclusions as specified in the Exclusions Section. Covered Benefits are provided if you have insulin dependent (Type I) diabetes, non-insulin dependent (Type 2) diabetes, and elevated blood glucose levels induced by pregnancy (gestational diabetes). We will guarantee Coverage for the equipment, appliances, Prescription Drug/Medications, insulin or supplies that meet the United States Food and Drug Administration (FDA) approval, and are the medically accepted standards for diabetes treatment, supplies and education. The following benefits are available when received from a Practitioner/Provider who is approved to provide diabetes education: · Medically Necessary visits upon the diagnosis of diabetes · Visits following a Practitioner/Provider diagnosis that represents a significant change in condition or symptoms requiring changes in the patient’s self-management · Visits when re-education or refresher training is prescribed by a healthcare Practitioner/Provider with prescribing authority · Telephonic visits with a Certified Diabetes Educator (CDE) · Medical nutrition therapy related to diabetes management Approved diabetes educators must be part of our In-Network Practitioners/Providers who are registered, certified or licensed Healthcare Professional with recent education in diabetes management. The following equipment, supplies, appliances, and services are Covered when prescribed by your Practitioner/Provider and when obtained through the designated network Provider: · Preferred insulin pumps - Some services require Prior Authorization. Refer to your · Specialized monitors/meters for the legally blind. · Medically Necessary Covered Podiatric appliances for prevention of feet complications associated with diabetes. Refer to the Durable Medical Equipment Benefits Section. · Preferred Prescriptive diabetic oral agents for controlling blood sugar levels – refer to your Formulary for Preferred agents. · Glucagon emergency kits. · Preferred insulin – refer to your Formulary for Preferred insulin. · Syringes. · Injection aids, including those adaptable to meet the needs of the legally blind. · Preferred blood glucose monitors/meters – refer to your Formulary for Preferred monitors. · Preferred test strips for blood glucose monitors – refer to your Formulary for Preferred test strips. · Preferred lancets and lancet devices. · Preferred continuous glucose monitoring (CGM) including (system, sensor, transmitter). Some services require ...
Diabetes Services. Diabetes Self-Management and Educational Services For Covered Persons with Type 1 or Type 2 diabetes, the following services are offered at $0 cost share: • Retinal eye exams, limited to 1 exam per plan year. • Certain lab tests specifically used to assess lipid levels, kidney function (including metabolic and urine) and glucose control (HgbA1C) in diabetics This does not apply to Covered Persons with pre- diabetes or gestational diabetes diagnoses. Depending upon where the Covered Health Care Service is provided, Benefits for diabetes self-management and training/diabetic eye exams/foot care will be the same as those stated under each Covered Health Care Service category in this Schedule of Benefits. Diabetes Self-Management Supplies Benefits for diabetes equipment that meets the definition of DME are subject to the limit stated under Durable Medical Equipment (DME). Depending upon where the Covered Health Care Service is provided, Benefits for diabetes self-management supplies will be the same as those stated under Durable Medical Equipment (DME) and in the Outpatient Prescription Drugs section. Benefits for diabetes supplies will be the same as those stated in the Outpatient Prescription Drugs section. SAMPLE Amounts which you are required to pay as shown below in the Schedule of Benefits are based on Allowed Amounts or, for specific Covered Health Care Services as described in the definition of Recognized Amount in the Policy, Recognized Amounts. The Allowed Amounts provision near the end of this Schedule of Benefits will tell you when you are responsible for amounts that exceed the Allowed Amount.
Diabetes Services. Diabetes Self-Management and Educational Services For Covered Persons with Type 1 or Type 2 diabetes, the following services are offered at $0 cost share: • Retinal eye exams, limited to 1 exam per plan year. • Certain lab tests specifically used to assess lipid levels, kidney function (including metabolic and urine) and glucose control (HgbA1C) in diabetics This does not apply to Covered Persons with pre- diabetes or gestational diabetes diagnoses. Depending upon where the Covered Health Care Service is provided, Benefits for diabetes self-management and training/diabetic eye exams/foot care will be the same as those stated under each Covered Health Care Service category in this Schedule of Benefits. SAMPLE
Diabetes Services. Diabetes Self-Management and Educational Services For Covered Persons with Type 1 or Type 2 diabetes, the following services are offered at $0 cost share: • Retinal eye exams, limited to 1 exam per plan year. • Certain lab tests specifically used to assess lipid levels, kidney function (including metabolic and urine) and glucose control (HgbA1C) in diabetics. This does not apply to Covered Persons with pre- Depending upon where the Covered Health Care Service is provided, Benefits for diabetes self-management and training/diabetic eye exams/foot care will be the same as those stated under each Covered Health Care Service category in this Schedule of Benefits. Amounts which you are required to pay as shown below in the Schedule of Benefits are based on Allowed Amounts or, for specific Covered Health Care Services as described in the definition of Recognized Amount in the Policy, Recognized Amounts. The Allowed Amounts provision near the end of this Schedule of Benefits will tell you when you are responsible for amounts that exceed the Allowed Amount.
Diabetes Services. In addition to Medically Necessary Covered Services for treatment of diabetes additional benefits are provided as follows:
A. Diabetes self-management and training, treatment, equipment and supplies.
B. Diabetes Equipment and Supplies
1. Diabetes equipment includes glucose monitoring equipment under the durable medical equipment coverage for Insulin-Using Beneficiaries. Insulin pumps are included if Medically Necessary. Diabetes supplies include coverage for insulin syringes and needles and testing strips for glucose monitoring equipment under the prescription drug coverage for Insulin-Using Beneficiaries.
Diabetes Services. Medically Necessary Diabetes treatment, as determined by HMO, includes:
1. Blood glucose monitors, including those for the legally blind;
2. Test strips;
3. Insulin preparation and glucagon;
4. Insulin cartridges, including those for the legally blind;
5. Drawing devices and monitors for the visually impaired;
6. Injection aids;
7. Syringes and lancets, including automatic lancing devices;
8. Podiatric appliances for the prevention of complications associated with Diabetes, to the extent such coverage is required under Medicare;
9. Prescribed oral agents for controlling blood sugar; and
10. Any other device, medication, equipment or supply for which coverage is required under Medicare after January 1, 1999. Such coverage is effective within six (6) months after it is required by Medicare.
