Exclusions and Limitations

Durable medical equipment (DME) is a covered benefit on all health plans. Refer to the Schedule of Benefits and coverage documents to determine exclusions and limitations, as applicable. Additional non-covered items are:

• Disposable supplies for home use
• Exercise or hygienic equipment, including shower chairs and bath tub lifts
• Corrective appliances (except casts, splints, and surgical dressings)
• Support appliances and such supplies as stockings, arch supports, foot orthotics (except when it is a foot orthotic that has been incorporated into a cast, brace or strapping of the foot or sleeves and gloves for lymphedema), and corrective shoes and devices unless member has a rider for custom footwear or is a diabetic
• Comfort items for example, diapers, incontinent pads, pillows, beds
• Contact or corrective lenses (except an implanted lens that replaces the organic eye lens) and eyeglasses (unless specifically provided elsewhere in the subscriber's Evidence of Coverage (EOC)
• Jacuzzi or whirlpool
• Fully electric beds
• More than one device for the same part of the body or more than one piece of equipment that serves the same function
• Running or sport devices, and other devices considered lightweight, when not medically necessary
• Consultations of an environmental engineer, air conditioners, humidifiers not used as part of DME equipment, dehumidifiers, purifiers, pillows, Jacuzzis, saunas, exercise equipment and bicycles, and elevators
• Replacement of lost devices