2023 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Durable Medical Equipment (DME)
Section 5. Benefits
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Durable Medical Equipment (DME)
Note: For Standard Option, we state whether or not the calendar year deductible applies for each benefit listed in this Section. There is no calendar year deductible under Basic Option.
Benefit Description
Durable Medical Equipment (DME)
Durable medical equipment (DME) is equipment and supplies that are:
We cover rental or purchase of durable medical equipment, at our option, including repair and adjustment. Covered items include:
Note: We cover DME at Preferred benefit levels only when you use a Preferred DME provider. Preferred physicians, facilities, and pharmacies are not necessarily Preferred DME providers.
Standard Option - You Pay
Preferred: 15% of the Plan allowance (deductible applies)
Participating: 35% of the Plan allowance (deductible applies)
Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount
Note: See Section 5(c) for our coverage of DME provided and billed by a facility.
Basic Option - You Pay
Preferred: 30% of the Plan allowance
Participating/Non-participating: You pay all charges
Note: See Section 5(c) for our coverage of DME provided and billed by a facility.
Benefit Description
Durable Medical Equipment (DME)
Durable medical equipment (DME) is equipment and supplies that are:
- Prescribed by your attending physician (i.e., the physician who is treating your illness or injury);
- Medically necessary;
- Primarily and customarily used only for a medical purpose;
- Generally useful only to a person with an illness or injury;
- Designed for prolonged use; and
- Used to serve a specific therapeutic purpose in the treatment of an illness or injury.
We cover rental or purchase of durable medical equipment, at our option, including repair and adjustment. Covered items include:
- Home dialysis equipment
- Oxygen equipment
- Hospital beds
- Wheelchairs
- Crutches
- Walkers
- Continuous passive motion (CPM) devices
- Dynamic orthotic cranioplasty (DOC) devices
- Insulin pumps
- Other items that we determine to be DME, such as compression stockings
Note: We cover DME at Preferred benefit levels only when you use a Preferred DME provider. Preferred physicians, facilities, and pharmacies are not necessarily Preferred DME providers.
Standard Option - You Pay
Preferred: 15% of the Plan allowance (deductible applies)
Participating: 35% of the Plan allowance (deductible applies)
Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount
Note: See Section 5(c) for our coverage of DME provided and billed by a facility.
Basic Option - You Pay
Preferred: 30% of the Plan allowance
Participating/Non-participating: You pay all charges
Note: See Section 5(c) for our coverage of DME provided and billed by a facility.
Benefit Description
Standard Option - You Pay
Any amount over $1,250 per year (no deductible)
Basic Option - You Pay
Any amount over $1,250 per year
- Speech-generating devices, limited to $1,250 per calendar year
Standard Option - You Pay
Any amount over $1,250 per year (no deductible)
Basic Option - You Pay
Any amount over $1,250 per year
Benefit Description
Not covered:
Standard Option - You Pay
All charges
Basic Option - You Pay
All charges
Not covered:
- Exercise and bathroom equipment
- Vehicle modifications, replacements, or upgrades
- Home modifications, upgrades, or additions
- Lifts, such as seat, chair, or van lifts
- Car seats
- Diabetic supplies, except as described in Section 5(f) or when Medicare Part B is primary
- Air conditioners, humidifiers, dehumidifiers, and purifiers
- Breast pumps, except as described on page 48
- Communications equipment, devices, and aids (including computer equipment) such as “story boards” or other communication aids to assist communication-impaired individuals (except for speech-generating devices as listed above)
- Equipment for cosmetic purposes
- Topical Hyperbaric Oxygen Therapy (THBO)
- Charges associated with separate or extended warranties
Standard Option - You Pay
All charges
Basic Option - You Pay
All charges