Common use of Prosthetics and Orthotic Devices Clause in Contracts

Prosthetics and Orthotic Devices. Benefits for external prosthetic devices (including fitting expenses) are covered when such devices are used to replace all or part of an absent body limb or to replace all or part of the function of a permanently inoperative or malfunctioning body organ. Benefits will only be provided for the initial purchase of a prosthetic device, unless the existing device cannot be repaired. Replacement devices must be prescribed by a physician because of a change in your physical condition. Shoe Inserts and Orthopedic Shoes Benefits are provided for medically necessary shoes, inserts or orthopedic shoes. Covered services also include training and fitting. Benefits are provided as shown in the Summary of Your Costs. This benefit does not cover: • Hypodermic needles, lancets, test strips, testing agents and alcohol swabs. These services are covered under the Prescription Drugs. • Supplies or equipment not primarily intended for medical use • Special or extra-cost convenience features • Items such as exercise equipment and weights • Whirlpools, whirlpool baths, portable whirlpool pumps, sauna baths and massage devices • Over bed tables, elevators, vision aids and telephone alert systems • Over the counter orthotic braces and or cranial banding • Non wearable defibrillator, trusses and ultrasonic nebulizers • Blood pressure cuff/monitor (even if prescribed by a physician) • Enuresis alarm • Compression stockings which do not require a prescription • Structural modifications to your home and/or personal vehicle • Orthopedic appliances prescribed primarily for use during participation of a sport, recreation or similar activity • Penile prostheses • Routine eye care services including eye glasses and contact lenses • Prosthetics, intraocular lenses, appliances or devices requiring surgical implantation. These items are covered under Surgery Services. Items provided and billed by a hospital are covered under the Hospital benefit for inpatient and outpatient care.

Prosthetics and Orthotic Devices. Benefits for external prosthetic devices (including fitting expenses) are covered when such devices are used to replace all or part of an absent body limb or to replace all or part of the function of a permanently inoperative or malfunctioning body organ. Benefits will only be provided for the initial purchase of a prosthetic device, unless the existing device cannot be repaired. Replacement devices must be prescribed by a physician because of a change in your physical condition. Shoe Inserts and Orthopedic Shoes Benefits are provided for medically necessary shoes, inserts or orthopedic shoes. Covered services also include training and fitting. Benefits are provided as shown in the Summary of Your Costs. This benefit does not cover: •  Hypodermic needles, lancets, test strips, testing agents and alcohol swabs. These services are covered under the Prescription Drugs. •  Supplies or equipment not primarily intended for medical use •  Special or extra-cost convenience features •  Items such as exercise equipment and weights •  Whirlpools, whirlpool baths, portable whirlpool pumps, sauna baths and massage devices •  Over bed tables, elevators, vision aids and telephone alert systems •  Over the counter orthotic braces and or cranial banding •  Non wearable defibrillator, trusses and ultrasonic nebulizers •  Blood pressure cuff/monitor (even if prescribed by a physician) •  Enuresis alarm •  Compression stockings which do not require a prescription •  Structural modifications to your home and/or personal vehicle •  Orthopedic appliances prescribed primarily for use during participation of a sport, recreation or similar activity •  Penile prostheses •  Routine eye care services including eye glasses and contact lenses •  Prosthetics, intraocular lenses, appliances or devices requiring surgical implantation. These items are covered under Surgery Services. Items provided and billed by a hospital are covered under the Hospital benefit for inpatient and outpatient care.

Prosthetics and Orthotic Devices. Benefits for external prosthetic devices (including fitting expenses) are covered when such devices are used to replace all or part of an absent body limb or to replace all or part of the function of a permanently inoperative or malfunctioning body organ. Benefits will only be provided for the initial purchase of a prosthetic device, unless the existing device cannot be repaired. Replacement devices must be prescribed by a physician because of a change in your physical condition. Shoe Inserts and Orthopedic Shoes Benefits are provided for medically necessary shoes, inserts or orthopedic shoes. Covered services also include training and fitting. Benefits are provided as shown in the Summary of Your Costs. This benefit does not cover: •  Hypodermic needles, lancets, test strips, testing agents and alcohol swabs. These services are covered under the Prescription Drugs. •  Supplies or equipment not primarily intended for medical use •  Special or extra-cost convenience features •  Items such as exercise equipment and weights •  Whirlpools, whirlpool baths, portable whirlpool pumps, sauna baths and massage devices •  Over bed tables, elevators, vision aids and telephone alert systems •  Over the counter orthotic braces and or cranial banding •  Non wearable defibrillator, trusses and ultrasonic nebulizers •  Blood pressure cuff/monitor (even if prescribed by a physician) •  Enuresis alarm •  Compression stockings which do not require a prescription •  Structural modifications to your home and/or personal vehicle •  Orthopedic appliances prescribed primarily for use during participation of a sport, recreation or similar activity •  Penile prostheses •  Routine eye care services including eye glasses and contact lenses •  Prosthetics, intraocular lenses, appliances or devices requiring surgical implantation. These items are covered under Surgery Services. Items provided and billed by a hospital are covered under the Hospital benefit for inpatient and outpatient care. OTHER COVERED SERVICES The services listed in this section are covered as shown on the Summary of Your Costs.

Prosthetics and Orthotic Devices. Benefits for external prosthetic devices (including fitting expenses) are covered when such devices are used to replace all or part of an absent body limb or to replace all or part of the function of a permanently inoperative or malfunctioning body organ. Benefits will only be provided for the initial purchase of a prosthetic device, unless the existing device cannot be repaired. Replacement devices must be prescribed by a physician because of a change in your physical condition. Shoe Inserts and Orthopedic Shoes Benefits are provided for medically necessary shoes, inserts or orthopedic shoes. Covered services also include training and fitting. Benefits are provided as shown in the Summary of Your Costs. This benefit does not cover: • Hypodermic needles, lancets, test strips, testing agents and alcohol swabs. These services are covered under the Prescription Drugs. • Supplies or equipment not primarily intended for medical use • Special or extra-cost convenience features • Items such as exercise equipment and weights • Whirlpools, whirlpool baths, portable whirlpool pumps, sauna baths and massage devices • Over bed tables, elevators, vision aids and telephone alert systems • Over the counter orthotic braces and or cranial banding • Non wearable defibrillator, trusses and ultrasonic nebulizers • Blood pressure cuff/monitor (even if prescribed by a physician) • Enuresis alarm • Compression stockings which do not require a prescription • Structural modifications to your home and/or personal vehicle • Orthopedic appliances prescribed primarily for use during participation of a sport, recreation or similar activity • Penile prostheses • Routine eye care services including eye glasses and contact lenses • Prosthetics, intraocular lenses, appliances or devices requiring surgical implantation. These items are covered under Surgery Services. Items provided and billed by a hospital are covered under the Hospital benefit for inpatient and outpatient care. OTHER COVERED SERVICES The services listed in this section are covered as shown on the Summary of Your Costs.

Prosthetics and Orthotic Devices. Benefits for external prosthetic devices (including fitting expenses) are covered when such devices are used to replace all or part of an absent body limb or to replace all or part of the function of a permanently inoperative or malfunctioning body organ. Benefits will only be provided for the initial purchase of a prosthetic device, unless the existing device cannot be repaired. Replacement devices must be prescribed by a physician because of a change in your physical condition. Shoe Inserts and Orthopedic Shoes Benefits are provided for medically necessary shoes, inserts or orthopedic shoes. Covered services also include training and fitting. Benefits are provided as shown in the Summary of Your Costs. This benefit does not cover: •  Hypodermic needles, lancets, test strips, testing agents and alcohol swabs. These services are covered under the Prescription Drugs. •  Supplies or equipment not primarily intended for medical use •  Special or extra-cost convenience features •  Items such as exercise equipment and weights •  Whirlpools, whirlpool baths, portable whirlpool pumps, sauna baths and massage devices •  Over bed tables, elevators, vision aids and telephone alert systems •  Over the counter orthotic braces and or cranial banding •  Non wearable defibrillator, trusses and ultrasonic nebulizers •  Blood pressure cuff/monitor (even if prescribed by a physician) •  Enuresis alarm •  Compression stockings which do not require a prescription •  Structural modifications to your home and/or personal vehicle •  Orthopedic appliances prescribed primarily for use during participation of a sport, recreation or similar activity •  Penile prostheses •  Routine eye care services including eye glasses and contact lenses • Prosthetics, intraocular lenses, appliances or devices requiring surgical implantation. These items are covered under Surgery Services. Items provided and billed by a hospital are covered under the Hospital benefit for inpatient and outpatient care.