Durable Medical Equipment and Braces Sample Clauses

Durable Medical Equipment and Braces. We cover the rental or purchase of durable medical equipment and braces.

Durable Medical Equipment and Braces. We Cover expenses incurred by You for medically necessary durable medical equipment and diabetes equipment. At Our option, covered expense includes the purchase or rental of durable medical equipment or diabetes equipment. If the cost of renting the equipment is more than you would pay to buy it, only the cost of the purchase is considered to be a covered expense. In either case, total covered expenses for durable medical equipment or diabetes equipment shall not exceed its purchase price. In the event we determine to purchase the durable medical equipment or diabetes equipment, any amount paid as rent for such equipment will be credited toward the purchase price. Repair and maintenance of purchased durable medical equipment and diabetes equipment is covered expense if: • Manufacturer's warranty is expired; • Repair or maintenance is not a result of misuse or abuse; • Maintenance is not more frequent than every six months; and • Repair cost is less than replacement cost. Replacement of purchased durable medical equipment and diabetes equipment is a covered expense if: • Manufacturer's warranty is expired; • Replacement cost is less than repair cost; and • Replacement is not due to lost or stolen equipment, or misuse or abuse of the equipment; or • Replacement is required due to a change in your condition that makes the current equipment non-functional. Upon Prior Authorization, We cover Medically Necessary gender dysphoria treatment. We will pay benefits for covered expenses incurred by you for a hospice care program. A health care practitioner must certify that the Member is terminally ill with a life expectancy of six (6) months or less. Covered Services will continue if the Member lives longer than six (6) months. Hospice care benefits are payable as shown on the "Schedule of Benefits" for the following hospice services, subject to the individual lifetime maximum benefit and any other maximum(s): • Room and board at a hospice, when it is for management of acute pain or for an acute phase of chronic symptom management; • Part-time nursing care provided by or supervised by a registered nurse (R.N.) for up to eight hours in any one day; • Counseling for the terminally ill Member and his/her immediate covered family members by a licensed Clinical social worker or Pastoral counselor. • Medical social services provided to the terminally ill covered person or his/her immediate covered family members under the direction of a health care practitioner, including:...