| HMO | Diabetic Treatment |
| Aetna US Healthcare | Complies with new laws. |
| Blue Cross Blue Shield | Covers: All medically appropriate and necessary diabetic related services, including equipment, supplies, medications and laboratory procedures. Also covers diabetic outpatient self-management training and educational services.
Limits: Limits may apply. |
| CIGNA / Healthsource | Covers: Medically necessary outpatient self-management training and education. Treatment and education are covered for diabetic medications and supplies in accordance with the state requirements. Diabetic medications and supplies are covered with or without a drug supplemental policy. Copayment may apply.
Limits: Outpatient facility self-management programs require prior approval. |
| Doctors Health Plan | Covers: Outpatient self-management training and educational services, equipment, supplies, medications and laboratory procedures used to treat diabetes.
Limits: Outpatient facility self-management programs and educational services require prior authorization. |
| Generations | Covers: Outpatient self-management training and educational services when approved in advance by Generations. Also covers equipment, supplies, medications and laboratory procedures related to the management of diabetes.
Limits: Insulin pumps require prior authorization. Excludes: Over the counter medication and supplies. |
| Optimum Choice | Covers: Medically necessary diabetes outpatient self-management training and educational services used to treat diabetes. |
| PARTNERS | Covers: Self-management training and educational services, equipment, supplies, medications and laboratory procedures used to treat diabetes.
Limits: Medications for members without a prescription rider are limited to a 30-day supply. In addition, individuals with prescription benefits through another plan are subject to coordination of benefits. Cost Sharing: Members without a prescription rider are subject to a copayment equal to the copayment required for an office visit. DME copayment or coinsurance applies to all equipment and supplies. Excludes: Experimental equipment and supplies, such as implantable insulin pumps. Portable external subcutaneous insulin pumps are covered with prior approval by the plan. |
| Coventry/Principal Health Care of the Carolinas | Covers: Medically necessary equipment, supplies, services, equipment, medications, and laboratory procedures. |
| QualChoice | Covers: Medically necessary diabetes outpatient self-management training and educational services, equipment, supplies, medications and laboratory procedures.
Limits: Qual Choice shall arrange for the provision of diabetes self-management training and education services. Cost Sharing: Cost Sharing may apply. |
| The Wellness Plan of North Carolina, Inc. | Covers: Approved outpatient self-management training and education that is medically necessary. |
| United HealthCare | Covers: Medically necessary services, supplies, medications, and laboratory procedures for the treatment of diabetes when ordered by a participating physician or a health care professional designated by the physician. Diabetes outpatient self-management training and educational services also covered if directed by a participating physician. |
| WellPath | Covers: Medically necessary services, supplies, medications and laboratory procedures for the treatment of diabetes. |