Diabetes. Expanded pharmacy coverage is limited to $0 Out-of-Pocket Cost select Tier 1 preferred generic medications and a reduction in Out-of-Pocket Cost for select Tier 2 generics and Tier 3 preferred brand medications as outlined below. On plans that apply a Deductible for Tier 2 and Tier 3 medications, the Deductible is waived and the Coinsurance or Copayment is reduced by half. On plans that have a copay for Tier 2 and Tier 3 medications, the copay is reduced by half. Select medications used to treat diabetes that are specified on our formulary and are approved by the federal Food and Drug Administration (FDA) are covered under this reduced Out-of-Pocket Cost benefit. Select medications included in the reduced Out-of-Pocket Cost benefit will be designated on the formulary as Chronic Illness Support Program medications and must be filled through the Home Delivery Program described in section 2.G.7. Medications we specify for inclusion under this program are among the most effective and of the highest value to treat the Chronic Illness as determined by us. The following services related to diabetes are covered with $0 Out-of-Pocket Cost when performed by a Network Provider (unless otherwise noted): • Office visits to a Primary Care Provider for routine management of diabetes • Endocrinology consultation and management of diabetes • Podiatry consultation for routine diabetic foot care • Nutritional counseling, diabetes education and behavioral modification counseling • Diabetic eye exam will be covered once a year • One glucometer each year as specified on the formulary and dispensed through our Home Delivery Program • Glucose test strips listed on formulary and dispensed through our Home Delivery Program: up to 50 every 30 days or 150 every 90 days at $0 Out-of-Pocket Cost. • Laboratory services linked to a diabetes primary diagnosis code and considered routine for the management of diabetes. Please note, if you have complications from diabetes and use an emergency department, have a Hospital stay, or get treated for heart or kidney problems, the usual and customary Plan costs for these services apply, and will be subject to standard Out-of-Pocket Costs as outlined in your Schedule of Benefits.
Appears in 2 contracts
Diabetes. Expanded pharmacy coverage is limited to $0 Out-of-Pocket Cost select Tier 1 preferred generic medications and a reduction in Out-of-Pocket Cost for select Tier 2 generics and Tier 3 preferred brand medications as outlined below. On plans that apply a Deductible for Tier 2 and Tier 3 medications, the Deductible is waived and the Coinsurance or Copayment is reduced by half. On plans that have a copay for Tier 2 and Tier 3 medications, the copay is reduced by half. Select medications used to treat diabetes that are specified on our formulary and are approved by the federal Food and Drug Administration (FDA) are covered under this reduced Out-of-Pocket Cost benefit. Select medications included in the reduced Out-of-Pocket Cost benefit will be designated on the formulary as Chronic Illness Support Program medications and must be filled through the Home Delivery Program described in section 2.G.7. Medications we specify for inclusion under this program are among the most effective and of the highest value to treat the Chronic Illness as determined by us. The following services related to diabetes are covered with $0 Out-of-Pocket Cost when performed by a Network Provider (unless otherwise noted): • Office visits to a Primary Care Provider for routine management of diabetes • Endocrinology consultation and management of diabetes • Podiatry consultation for routine diabetic foot care • Nutritional counseling, diabetes education and behavioral modification counseling • Diabetic eye exam will be covered once a year • One glucometer each year as specified on the formulary and dispensed through our Home Delivery Program • Glucose test strips listed on formulary and dispensed through our Home Delivery Program: up to 50 every 30 days or 150 every 90 days at $0 Out-of-Pocket Cost. • Laboratory services linked to a diabetes primary diagnosis code and considered routine for the management of diabetes. Please note, if you have complications from diabetes and use an emergency department, have a Hospital stay, or get treated for heart or kidney problems, the usual and customary Plan costs for these services apply, and will be subject to standard Out-of-Pocket Costs as outlined in your Schedule of Benefits. Insulin pumps and supplies are considered Durable Medical Equipment (DME).
Appears in 2 contracts
