2026 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 50

 

Benefit Description

Orthopedic and Prosthetic Devices (cont.)

Note: A prosthetic appliance is a device that is surgically inserted or physically attached to the body to restore a bodily function or replace a physical portion of the body.

We provide hospital benefits for internal prosthetic devices, such as artificial joints, pacemakers, cochlear implants, and surgically implanted breast implants following mastectomy; see Section 5(c) for payment information. Insertion of the device is paid as surgery; see Section 5(b).


You Pay
Preferred: 30% of the Plan allowance (deductible applies)

Non-preferred (Participating/Non-participating): You pay all charges

 

Not covered:
 
  • Shoes (including diabetic shoes)
     
  • Over-the-counter orthotics
     
  • Arch supports
     
  • Heel pads and heel cups
     
  • Wigs (including cranial prostheses)

  • Hearing aids, including bone anchored hearing aids, accessories or supplies (including remote controls and warranty packages) and all associated services


You Pay
All charges

 

Benefit Description

Durable Medical Equipment (DME)
Durable medical equipment (DME) is equipment and supplies that are:
 
  1. Prescribed by your attending physician (i.e., the physician who is treating your illness or injury);
     
  2. Medically necessary;
     
  3. Primarily and customarily used only for a medical purpose;
     
  4. Generally useful only to a person with an illness or injury;
     
  5. Designed for prolonged use; and
     
  6. Used to serve a specific therapeutic purpose in the treatment of an illness or injury.

We cover rental or purchase of prescribed 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
     
  • Specialty DME* to include:
     
    • Specialty hospital beds
       
    • Deluxe wheelchairs, power wheelchairs and mobility devices including scooters and related supplies.


You Pay
Preferred: 30% of the Plan allowance (deductible applies)

Non-preferred (Participating/Non-participating): You pay all charges

 

Durable Medical Equipment (DME) - continued on next page