Common use of Durable Medical Equipment (DME), Medical Supplies Clause in Contracts

Durable Medical Equipment (DME), Medical Supplies. Diabetic Supplies, Prosthetic Devices, and Enteral Formula or Food, Hair Prosthetics Outpatient durable medical equipment* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient medical supplies* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient diabetic supplies/equipment purchased at licensed medical supply provider (other than a pharmacy). See the Summary of Pharmacy Benefits for supplies purchased at a pharmacy. 20% - After deductible 40% - After deductible Outpatient prosthesis* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Enteral formula delivered through a feeding tube. Must be sole source of nutrition. 20% - After deductible 40% - After deductible Enteral formula or food taken orally * 20% - After deductible The level of coverage is the same as network provider. Hair prosthesis (wigs) - The benefit limit is $350 per hair prosthesis (wig) when worn for hair loss suffered as a result of cancer treatment. 20% - After deductible The level of coverage is the same as network provider.

Durable Medical Equipment (DME), Medical Supplies. Diabetic Supplies, Prosthetic Devices, and Enteral Formula or Food, Hair Prosthetics Outpatient durable medical equipment* - Must be provided by a licensed medical supply provider. 20% - After deductible 4020% - After deductible Outpatient medical supplies* - Must be provided by a licensed medical supply provider. 20% - After deductible 4020% - After deductible Outpatient diabetic supplies/equipment purchased at licensed medical supply provider (other than a pharmacy). See the Summary of Pharmacy Benefits for supplies purchased at a pharmacy. 20% - After deductible 4020% - After deductible Outpatient prosthesis* - Must be provided by a licensed medical supply provider. 20% - After deductible 4020% - After deductible Enteral formula delivered through a feeding tube. Must be sole source of nutrition. 20% - After deductible 4020% - After deductible Enteral formula or food taken orally * 20% - After deductible The level of coverage is the same as network providercare coordinated by your primary care physician and permitted self-referrals. Hair prosthesis (wigs) - The benefit limit is $350 per hair prosthesis (wig) when worn for hair loss suffered as a result of cancer treatment. 20% - After deductible The level of coverage is the same as network providercare coordinated by your primary care physician and permitted self-referrals.