Orthotics Benefits Sample Clauses

Orthotics Benefits. Benefits are provided for orthotic appliances and devices for maintaining normal Activities of Daily Living only. Benefits include:

Orthotics Benefits. Benefits are provided for orthotic appliances and devices for maintaining normal Activities of Daily Living only. Benefits include: Benefits are provided for X-ray services, diagnos- tic testing, clinical pathology, and laboratory ser- vices when provided to diagnose illness or injury. Benefits are provided for genetic testing for at-risk Members according to Blue Shield medical policy and for prenatal genetic screening and diagnostic services as follows:

Orthotics Benefits. Benefits are provided for orthotic appliances, including:  Shoes only when permanently attached to such applianc- es;  Special footwear required for foot disfigurement which includes, but is not limited to, foot disfigurement from cerebral palsy, arthritis, polio, xxxxx bifida, and foot dis- figurement caused by accident or developmental disabil- ity;  Medically Necessary knee braces for post-operative re- habilitation following ligament surgery, instability due to injury, and to reduce pain and instability for patients with osteo-arthritis;  Medically Necessary functional foot orthoses that are custom made rigid inserts for shoes, ordered by a physi- cian or podiatrist, and used to treat mechanical problems of the foot, ankle or leg by preventing abnormal motion and positioning when improvement has not occurred with a trial of strapping or an over-the-counter stabilizing device;  Initial fitting and replacement after the expected life of the orthosis is covered. Benefits are provided for orthotic devices for maintaining normal Activities of Daily Living only. No benefits are pro- vided for orthotic devices such as knee braces intended to provide additional support for recreational or sports activities or for orthopedic shoes and other supportive devices for the feet. No benefits are provided for backup or alternate items. Benefits are limited to a per Member, per Calendar Year maximum as shown in the Summary of Benefits. This max- imum does not apply to Services covered under the Diabetes Care benefit.

Orthotics Benefits. 44 Outpatient or Out-of-Hospital X-Ray, Pathology, and/or Laboratory Benefits 44 Outpatient Rehabilitation Benefits 45 Outpatient Prescription Drug Benefits 45 PKU Related Formulas and Special Food Products Benefits 49 Podiatric Benefits 49 Pregnancy Benefits 49 Preventive Health Benefits 49 Professional (Physician) Benefits 51 Prosthetic Appliance Benefits 52 Radiological and Nuclear Imaging Benefits 52 Skilled Nursing Facility Benefits 53 Speech Therapy Benefits 53 Transplant Benefits 53 General Exclusions and Limitations 54 Medical Necessity Exclusion 57 Pre-Existing Conditions 57 Limitations for Duplicate Coverage 58 Exception for other Coverage 58 Claims Review 58 Reductions - Acts of Third Parties 59 Independent Contractors 59 Non-Assignability 59 Plan Interpretation 60 Confidentiality of Personal and Health Information 60 Access to Information 60 Entire Agreement: Changes 60 Legal Process 60 Organ and Tissue Donation 60 Choice of Providers 60 Endorsements and Appendices 61 Grace Period 61 Notices 61 Commencement or Termination of Coverage 61 Identification Cards 61 Statutory Requirements 61 Notice 61 Public Policy Participating Procedure 61 Procedure 62 For all Services other than Mental Health 62 For all Mental Health Services 62 For all Services other than Mental Health 63 For all Mental Health Services 63 External Independent Medical Review 63 Department of Managed Health Care Review 64 Plan Provider Definitions 64 All Other Definitions 66 Note: The Summary of Benefits represents only a brief description of the Benefits. Please read this Agreement carefully for a com- plete description of provisions, benefits, exclusions, and other important information pertaining to this Plan. Note: For Benefits that have a visit maximum, all visits count toward the visit maximum, regardless of whether the Calendar Year Deductible has been satisfied, or you have reached the Calendar Year Out-of Pocket Maximum Responsibility.