Coverage

The following information applies only to participating physician groups (PPGs), physicians and ancillary providers.

Orthotics are rigid or semi-rigid devices affixed to the body externally and required to support or correct a defect of form or function of a permanently inoperative or malfunctioning body part, or to restrict motion in a diseased or injured part of the body. Orthotic items are covered through the durable medical equipment (DME) benefit and paid for as shared-risk.

Orthotic items that can be purchased over the counter are not covered. Foot orthotics, except when incorporated into a cast, brace or strapping of the foot, are not covered, unless specifically purchased as coverage by the employer.

Orthotic services are not available through Health Net's preferred DME provider (Apria). They may be obtained through prosthetic and orthotic providers, such as Linkia, LLC.

The following information applies only to participating physician groups (PPGs), physicians and ancillary providers.

Durable medical equipment (DME) is a covered benefit on most health plans. Refer to the Schedule of Benefits to determine whether DME is covered on the member's plan and to determine exclusions, limitations and applicable. Additional non-covered items are:

• Disposable supplies, except ostomy bags, urinary catheters and supplies consistent with Medicare coverage guidelines
• Exercise or hygienic equipment
• Experimental or research equipment
• Comfort or convenience items
• Devices not medical in nature, such as sauna baths and elevators, or modification to the home or automobile
• Deluxe equipment
• More than one piece of equipment that serves the same function