Limits: BCBS will decide whether to buy or rent the equipment. Payments are limited per calendar year. Prior approval is required for purchases over a specified amount.

Cost Sharing: Coinsurance applies.

Coverage of customized DME: Not listed in Evidence of Coverage.

Excludes: Eyeglasses, hearing aids, or "deluxe appliances." BCBS does not cover DME that are primarily for convenience purposes. If the equipment is determined to be no longer medically necessary, BCBS may ask it to be returned.

Limits: CHCNC reserves the right to determine whether rental or purchase is more appropriate. Repair and replacement of these items are covered with prior authorization when requested by a participating provider. Maximum benefit applies.

Cost Sharing: Copayment applies.

Coverage of customized DME: Not listed in Evidence of Coverage.

Excludes: Non-durable goods for use with a durable medical equipment item; repair or replacements when due to misuse or loss.

Limits: Must be requested by participating provider and approved in advance by the plan. Doctors’ reserves the right to determine whether rental or purchase is more appropriate. Must be provided by participating provider or facility unless there is no participating provider available.

Excludes: Repairs and replacement if needed because of misuse or loss.

Limits: DME must be requested by the PCP and authorized in advance by Generations. Customized DME covered with prior authorization from Generations.

Excludes: Deluxe versions of durable medical equipment or prosthetic devices will not be covered unless medically necessary. Also excludes non-medically necessary appliances.

Limits: OCCI reserves the right to determine rental, purchase, or repair of DME. Coverage for home oxygen must be:

• Certified by the prescribing provider that the results of recent arterial blood gas and/or oxygen saturation tests on the patient (on room air if possible) indicate hypoxemia.
• Such tests must be approved by OCCI.

Cost Sharing: 50% coinsurance for all DME. This payment is waived if the DME eliminates a hospital admission.

Limits: DME must be prescribed and arranged by PCP and authorized in advance by plan. Partners maintains a list of covered DME and the conditions under which they are covered.

Partners reserves right to select source from which DME is purchased or leased, as well as the model or style. Benefits limited for the following: $1,200 for manual wheelchair; $3,000 for motorized wheelchair. Excludes: Replacement of lost, stolen, or improperly used equipment.

Cost Sharing: Coinsurance applies to most DME, except wheelchairs.

Limits: The combined total maximum benefit is limited to $1,000 per member per calendar year.

Excludes: DME that does not serve a medical purpose, cannot be used in a member’s home, and is generally not useful to a person without illness, injury or disease.

Limits: DME must be ordered by a physician and provided by a physician supplier or pharmacy. Qual Choice will determine whether the equipment will be rented or purchased.

Cost Sharing: Cost Sharing may apply. The maximum payment is the purchase price of the equipment.

Excludes: Air conditioners, humidifiers, dehumidifiers, air purifiers and exercise equipment.

Excludes: All other durable medical equipment, including batteries and hearing aids, loss, theft and wear and tear before 24 months of use.

Limits: Prior approval required for any items costing more than $500.

Cost Sharing: Copayments may apply.

Excludes: Repair, replacement and duplicates except when a child outgrows the equipment. Also excludes equipment considered a personal comfort item (such as air conditioners, humidifiers, dehumidifiers, or special vacuum cleaners).

Supplemental policy covers: The rental or purchase of standard durable medical equipment, such as non-motorized wheelchairs, crutches and canes, leg or back braces, traction equipment, oxygen equipment, or hospital beds.

Limits: DME must be prescribed by a participating provider and approved in advance by WellPath. The decision to rent or purchase covered equipment is at the discretion of WellPath. Purchased equipment is the property of WellPath and must be returned to WellPath when the equipment is no longer medically necessary or the member’s coverage terminates under the plan. WellPath covers maintenance, repair and replacement unless due to member’s inappropriate use of such equipment.

Excludes: Comfort or convenience items, bed boards, bath lifts, over-bed tables, air purifiers, exercise equipment, stethoscopes, and blood pressure gauges. The replacement of covered DME which is lost, misplaced, or stolen is also excluded.