Common use of Orthotic Appliances Clause in Contracts

Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body function. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Pre-fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances including: o Podiatric Appliances for prevention of feet complications associated with diabetes o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see the Diabetes section. Prosthetic Devices Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: • breast prostheses when required because of mastectomy and prophylactic mastectomy • artificial limbs • prosthetic eye • prosthodontic appliances • penile prosthesis • joint replacements • heart pacemakers • tracheostomy tubes and cochlear implants

Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body functionfunction including clubfoot deformity. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Pre-Custom fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances orthotic appliance including: o Podiatric Appliances appliances for prevention of feet complications associated with diabetes diabetes. o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see the Diabetes sectionSection. Prosthetic Devices Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions removal and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: • breast prostheses when required because of mastectomy and prophylactic mastectomy • artificial limbs • prosthetic eye • prosthodontic appliances • penile prosthesis • joint replacements • heart pacemakers • tracheostomy tubes and cochlear implants

Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body functionfunction including clubfoot deformity. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Pre-Custom fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances including: o Podiatric Appliances appliances for prevention of feet complications associated with diabetes Diabetes. o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see the Diabetes sectionSection. Prosthetic Devices Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions removal and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: • breast prostheses when required because of mastectomy and prophylactic mastectomy • artificial limbs • prosthetic eye • prosthodontic appliances • penile prosthesis • joint replacements • heart pacemakers pacemakers‌‌ • tracheostomy tubes and cochlear implants

Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body functionfunction including clubfoot deformity. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Pre-Custom fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances including: o Podiatric Appliances appliances for prevention of feet complications associated with diabetes diabetes. o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see the Diabetes sectionSection. Prosthetic Devices Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions removal and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: • breast prostheses when required because of mastectomy and prophylactic mastectomy • artificial limbs • prosthetic eye • prosthodontic appliances • penile prosthesis • joint replacements • heart pacemakers • tracheostomy tubes and cochlear implants

Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body function. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Pre-fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances including: o Podiatric Appliances appliances for prevention of feet complications associated with diabetes o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see the Diabetes sectiondiabetes. Prosthetic Devices Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions removal and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: to:‌ • breast prostheses when required because of mastectomy and prophylactic mastectomy • artificial limbs • prosthetic eye • prosthodontic appliances • penile prosthesis • joint replacements • heart pacemakers • tracheostomy tubes and cochlear implants

Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body function. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Pre-fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances including: o Podiatric Appliances appliances for prevention of feet complications associated with diabetes o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see the Diabetes sectiondiabetes. Prosthetic Devices Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: to:‌ • breast prostheses when required because of mastectomy and prophylactic mastectomy • artificial limbs • prosthetic eye • prosthodontic appliances • penile prosthesis • joint replacements • heart pacemakers • tracheostomy tubes and cochlear implants

Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body functionfunction including clubfoot deformity. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Pre-Custom fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances including: o Podiatric Appliances appliances for prevention of feet complications associated with diabetes o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see the Diabetes sectiondiabetes. Prosthetic Devices Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions removal and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Authorization.‌ Examples of Prosthetic Devices include, but are not limited to: • breast prostheses when required because of mastectomy and prophylactic mastectomy • artificial limbs • prosthetic eye • prosthodontic appliances • penile prosthesis • joint replacements • heart pacemakers • tracheostomy tubes and cochlear implants

Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body function. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Pre-fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances including: o Podiatric Appliances appliances for prevention of feet complications associated with diabetes o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see the Diabetes sectiondiabetes. Prosthetic Devices Standard Devices‌‌ Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions removal and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: • breast prostheses when required because of mastectomy and prophylactic mastectomy • artificial limbs • prosthetic eye • prosthodontic appliances • penile prosthesis • joint replacements • heart pacemakers • tracheostomy tubes and cochlear implants

Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body functionfunction including clubfoot deformity. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Pre-Custom fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances including: o Podiatric Appliances appliances for prevention of feet complications associated with diabetes o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see the Diabetes sectiondiabetes. Prosthetic Devices Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions removal and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: to:‌ • breast prostheses when required because of mastectomy and prophylactic mastectomy • artificial limbs • prosthetic eye • prosthodontic appliances • penile prosthesis • joint replacements • heart pacemakers • tracheostomy tubes and cochlear implants

Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body function. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other significant neuropathy. • Pre-fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. guidelines.‌ • Covered Orthotic Appliances including: o Podiatric Appliances appliances for prevention of feet complications associated with diabetes o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see the Diabetes sectiondiabetes. Prosthetic Devices Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions removal and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: • breast prostheses when required because of mastectomy and prophylactic mastectomy • artificial limbs • prosthetic eye • prosthodontic appliances • penile prosthesis • joint replacements • heart pacemakers • tracheostomy tubes and cochlear implants

Orthotic Appliances. Orthotic Appliances include braces and other external devices used to correct a body functionfunction including clubfoot deformity. Orthotic Appliances must be Medically Necessary and may require Prior Authorization. Orthotic Appliances are subject to the following limitations: • Foot Orthotics or shoe appliances are not Covered, except for our Members with diabetic neuropathy or other another significant neuropathy. • Pre-fabricated knee-ankle-foot orthoses (KAFO) and ankle-foot orthoses (AFO) are Covered for our Members in accordance with nationally recognized guidelines. • Covered Orthotic Appliances including: o Podiatric Appliances appliances for prevention of feet complications associated with diabetes Diabetes. o Repair and replacement of durable medical equipment, prosthetics and orthotic devices must comport with state law. Please see the Diabetes sectionSection. Prosthetic Devices Devices‌‌ Standard Prosthetic Devices are artificial devices, which replace or augment a missing or impaired part of the body. The purchase, fitting and necessary adjustments of Prosthetic Devices and supplies that replace all or part of the function of a permanently inoperative or malfunctioning body part are Covered when they replace a limb or other part of the body, after accidental or surgical removal, congenital conditions conditions, and/or when the body’s growth necessitates replacement. Prosthetic Devices must be Medically Necessary and may require Prior Authorization. Examples of Prosthetic Devices include, but are not limited to: • breast Breast prostheses when required because of mastectomy and prophylactic mastectomy o Prosthetics related to other Medically Necessary services for Gender Confirmatory therapy and Gender Affirming care are Covered • artificial Artificial limbs • prosthetic Prosthetic eye • prosthodontic Prosthodontic appliances • penile Penile prosthesis • joint Joint replacements • heart Heart pacemakers • tracheostomy Tracheostomy tubes and cochlear implants