Enteral. Nutrition Benefits are provided for specialized enteral formulas administered either orally or by tube feeding for certain conditions under the direction of a Physician. Benefits also include medical food for Covered Persons with metabolic disorders when ordered by a Physician qualified to provide diagnosis and treatment in the field of metabolic disorders. Benefits for nutritional services include unlimited nutritional counseling and medical nutrition therapy.
Enteral. Nutrition Enteral nutrition involves the use of special formulas and medical foods that are administered by mouth or through a tube placed in the gastrointestinal tract. Benefits for enteral nutrition include enteral nutrition products (i.e. special formulas and medical foods, as defined by the U.S. Food and Drug Administration), as well as Medically Necessary enteral feeding equipment (e.g. pumps, tubing, etc.). Benefits for enteral nutrition products are covered as standard Member Cost-Sharing Amounts if the enteral nutrition product provides fifty percent (50%) or more of total nutritional intake. Regardless of percentage nutritional intake, Benefits for enteral nutrition products for the therapeutic treatment of phenylketonuria, branched-chain ketonuria, galactosemia, and homocystinuria are covered and are exempt from Deductibles; however, all other Member cost-sharing will apply. Similarly, Benefits for amino acid- based enteral nutrition products are covered for documented food protein allergies, food protein-induced enterocolitis syndrome, eosinophilic disorders, and short-bowel syndrome; however, all standard Member Cost-Sharing Amounts (including Deductibles) will apply. Benefits for Medically Necessary enteral feeding equipment for feeding through a tube are included for individuals with functioning gastrointestinal tracts, but for whom oral feeding is impossible or severely limited.
Enteral. Nutrition Enteral nutrition involves the use of special formulas and medical foods that are administered by mouth or through a tube placed in the gastrointestinal tract. Benefits for enteral nutrition include enteral nutrition products (i.e. special formulas and medical foods), as well as Medically Necessary enteral feeding equipment (e.g. pumps, tubing, etc). Benefits for enteral nutrition products are included when administered by any method for the therapeutic treatment of phenylketonuria, branched-chain ketonuria, galactosemia, and homocystinuria. Covered enteral nutrition products for these four conditions are exempt from Deductibles. Benefits for enteral nutrition products are also included for medical foods, as defined by the U.S. Food and Drug Administration, that are administered orally or through a tube, and that provide fifty (50%) percent or more of total nutritional intake. Benefits for Medically Necessary enteral feeding equipment for feeding through a tube are included for individuals with functioning gastrointestinal tracts, but for whom oral feeding is impossible or severely limited.
