Common use of Diabetic Care Clause in Contracts

Diabetic Care. For medically necessary services and supplies used in the treatment of persons with gestational, type I or type II diabetes. Covered service expenses include, but are not limited to, medically necessary telehealth services; exams including podiatric exams; routine foot care such as trimming of nails and corns; laboratory and radiological diagnostic testing; self-management equipment, and supplies such as urine or ketone strips, blood glucose monitor supplies (glucose strips) for the device, and syringes or needles; orthotics and diabetic shoes; urinary protein/microalbumin and lipid profiles; educational health and nutritional counseling for self-management; eye examinations; prescription medication; and one retinopathy examination screening per year. The supplies, equipment and appliances described below are covered services under this benefit. If the supplies, equipment and appliances include comfort, luxury, or convenience items or features which exceed what is medically necessary in your situation or needed to treat your condition, reimbursement will be based on the maximum allowed amount for a standard item that is a covered service, serves the same purpose, and is medically necessary. Any expense that exceeds the maximum allowable amount for the standard item which is a covered service is your responsibility. For example, the reimbursement for a motorized wheelchair will be limited to the reimbursement for a standard wheelchair, when a standard wheelchair adequately accommodates your condition. Repair, adjustment and replacement of purchased equipment, supplies or appliances as set forth below may be covered, as approved by us. The repair, adjustment or replacement of the purchased equipment, supply or appliance is covered if: • The equipment, supply or appliance is a covered service; • The continued use of the item is medically necessary; and • There is reasonable justification for the repair, adjustment, or replacement (warranty expiration is not reasonable justification). In addition, replacement of purchased equipment, supplies or appliance may be covered if:

Diabetic Care. For medically necessary services and supplies used in the treatment of persons with gestational, type I or type II diabetes. Covered service expenses include, but are not limited to, medically necessary telehealth services; exams examinations including podiatric examsexaminations; routine foot care such as trimming of nails and corns; laboratory and radiological diagnostic testing; self-management equipment, and supplies such as urine or ketone strips, blood glucose monitor supplies (glucose strips) for the device, and syringes or needles; orthotics and diabetic shoes; urinary protein/microalbumin and lipid profiles; educational health and nutritional counseling for self-management; eye examinations; prescription medication; and one retinopathy examination screening per year. The supplies, equipment and appliances described below are covered services under this benefit. If the supplies, equipment and appliances include comfort, luxury, or convenience items or features which exceed what is medically necessary in your situation or needed to treat your condition, reimbursement will be based on the maximum allowed amount for a standard item that is a covered service, serves the same purpose, and is medically necessary. Any expense that exceeds the maximum allowable allowed amount for the standard item which is a covered service is your responsibility. For example, the reimbursement for a motorized wheelchair will be limited to the reimbursement for a standard wheelchair, when a standard wheelchair adequately accommodates your condition. Repair, adjustment and replacement of purchased equipment, supplies or appliances as set forth below may be covered, as approved by us. The repair, adjustment or replacement of the purchased equipment, supply or appliance is covered if: • The equipment, supply or appliance is a covered service; • The continued use of the item is medically necessary; and • There is reasonable justification for the repair, adjustment, or replacement (warranty expiration is not reasonable justification). In addition, replacement of purchased equipment, supplies or appliance may be covered if: