Diabetic Equipment and Supplies. In accordance with Rhode Island General Law §27-20-30, this agreement provides coverage for the following medically necessary diabetic equipment and supplies, subject to medical necessity review: • therapeutic/molded shoes for the prevention of amputation are covered for the treatment of diabetes; our allowance for molded shoes includes the initial inserts. Additional medically necessary inserts for custom-molded shoes are covered; • blood glucose monitors, blood glucose monitors for the legally blind, external insulin infusion pumps and appurtenances thereto, insulin infusion devices and injection aids for the treatment of insulin treated diabetes, non-insulin treated diabetes and gestational diabetes; and • test strips for glucose monitors and/or visual reading, cartridges for the legally blind, and infusion sets for external insulin pumps for the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes. See the Summary of Medical Benefits for benefit limits and the amount you pay. Covered diabetic equipment and supplies bought at a licensed medical supply provider are subject to the benefit limits and the amount you pay as shown in the Summary of Medical Benefits.
Diabetic Equipment and Supplies. In accordance with Rhode Island General Law §27-20-30, this agreement provides coverage for the following medically necessary diabetic equipment and supplies, subject to medical necessity review: therapeutic/molded shoes for the prevention of amputation are covered for the treatment of diabetes; our allowance for molded shoes includes the initial inserts. Additional medically necessary inserts for custom-molded shoes are covered; blood glucose monitors, blood glucose monitors for the legally blind, external insulin infusion pumps and appurtenances thereto, insulin infusion devices and injection aids for the treatment of insulin treated diabetes, non-insulin treated diabetes and gestational diabetes; and test strips for glucose monitors and/or visual reading, cartridges for the legally blind, and infusion sets for external insulin pumps for the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes. See the Summary of Medical Benefits for benefit limits and the amount you pay. Covered diabetic equipment and supplies bought at a licensed medical supply provider are subject to the benefit limits and the amount you pay as shown in the Summary of Medical Benefits. Some diabetic equipment and supplies can be bought at a network pharmacy. When bought at a network pharmacy, the covered diabetic equipment and supplies are subject to the benefit limits and the amount you pay as shown in the Summary of Pharmacy Benefits. See Section 3.27 - Prescription Drugs.
Diabetic Equipment and Supplies. When purchased at a Retail or Specialty Pharmacy. Glucometers, Test Strips, Lancet and Lancet Devices, and Miscellaneous Supplies (including calibration fluid). Tier 1: $10 Tier 2: $50 Tier 3: $0 - After deductible Tier 4 and Tier 5: Diabetic equipment and supplies are only placed in Tier 1, Tier 2 or Tier 3. See above. Not Covered
