Prostheses. Internal and external prostheses required to replace a body part are covered. Examples are artificial legs, surgically implanted hip joints, devices to restore speaking after laryngectomy and visual aids (excluding eyewear) to assist the visually impaired with proper dosing of insulin. Also covered are internally implanted devices such as heart pacemakers. In addition, prostheses to restore symmetry after a Medically Necessary mastectomy are covered. The device must be among those that the Food and Drug Administration has approved for general use. If two or more types of medically appropriate devices are available, Health Net will determine which device or appliance will be covered. Prostheses will be replaced when no longer functional. However, repair or replacement for loss or misuse is not covered. Health Net will decide whether to replace or repair an item. Organ, tissue and stem cell transplants that are not Experimental or Investigational are covered if the transplant is authorized under SELECT 1 or precertified under SELECT 2 by Health Net and performed at a Health Net Transplant Performance Center. Health Net has a specific network of designated Transplant Performance Centers to perform organ, tissue and stem cell transplants. Your Member Physician can provide you with information about our Transplant Performance Centers. You will be directed to a designated Health Net Transplant Performance Center at the time authorization or precertification is obtained. Preferred Providers that are not designated as part of Health Net’s network of Transplant Performance Centers are considered Out-of-Network Providers for purposes of determining coverage and benefits for transplants and transplant-related services. Medically Necessary services, in connection with an organ, stem cell or tissue transplant are covered as follows: • For the enrolled Member who receives the transplant; and • For the Donor (whether or not an enrolled Member). Benefits are reduced by any amounts paid or payable by the donor’s own coverage. Only Medically Necessary services related to the organ donation are covered. Evaluation of potential candidates is subject to prior authorization. More than one evaluation (including tests) at more than one transplant center will not be authorized unless it is Medically Necessary. Organ donation extends and enhances lives and is an option that you may want to consider. For more information on organ donation, including how to elect to be an organ donor, please contact the Customer Contact Center at the telephone number on your Health Net ID Card, or visit the Department of Health and Human Services organ donation website at ▇▇▇.▇▇▇▇▇▇▇▇▇▇.▇▇▇. Charges for reasonable and appropriate computer searches for acceptable organs and tissues are not covered under SELECT 2. Travel expenses and hotel accommodations associated with organ, tissue and stem cell transplants are not covered. A limited Chiropractic benefit is available. Expenses related to or connected with the detection or correction by manual or mechanical means of structural imbalance, distortion or subluxation; where such care is for the purpose of removing nerve interference and its effects and where interference is the result of or related to distortion, misalignment or subluxation of or in the spinal column. Chiropractic Services and Supplies are limited by a number of visits indicated in the "Schedule of Benefits and Copayments - SELECT 2 and SELECT 3" sections.
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Prostheses. Internal and external prostheses required to replace a body part are covered. Examples are artificial legs, surgically implanted hip joints, devices to restore speaking after laryngectomy and visual aids (excluding eyewear) to assist the visually impaired with proper dosing of insulin. Also covered are internally implanted devices such as heart pacemakers. In addition, prostheses to restore symmetry after a Medically Necessary mastectomy are covered. The device must be among those that the Food and Drug Administration has approved for general use. If two or more types of medically appropriate devices are available, Health Net will determine which device or appliance will be covered. Prostheses will be replaced when no longer functional. However, repair or replacement for loss or misuse is not covered. Health Net will decide whether to replace or repair an item. Organ, tissue and stem cell transplants that are not Experimental or Investigational are covered if the transplant is authorized under SELECT 1 or precertified under SELECT 2 by Health Net and performed at a Health Net Transplant Performance Center. Health Net has a specific network of designated Transplant Performance Centers to perform organ, tissue and stem cell transplants. Your Member Physician can provide you with information about our Transplant Performance Centers. You will be directed to a designated Health Net Transplant Performance Center at the time authorization or precertification is obtained. Preferred Providers that are not designated as part of Health Net’s network of Transplant Performance Centers are considered Out-of-Network Providers for purposes of determining coverage and benefits for transplants and transplant-related services. Medically Necessary services, in connection with an organ, stem cell or tissue transplant are covered as follows: • For the enrolled Member who receives the transplant; and • For the Donor (whether or not an enrolled Member). Benefits are reduced by any amounts paid or payable by the donor’s own coverage. Only Medically Necessary services related to the organ donation are covered. Evaluation of potential candidates is subject to prior authorization. More than one evaluation (including tests) at more than one transplant center will not be authorized unless it is determined to be Medically Necessary. Organ donation extends and enhances lives and is an option that you may want to consider. For more information on organ donation, including how to elect to be an organ donor, please contact the Customer Contact Center at the telephone number on your Health Net ID Card, or visit the Department of Health and Human Services organ donation website at ▇▇▇.▇▇▇▇▇▇▇▇▇▇.▇▇▇. Charges for reasonable and appropriate computer searches for acceptable organs and tissues are not covered under SELECT 2. Travel expenses and hotel accommodations associated with organ, tissue and stem cell transplants are not covered. A limited Chiropractic benefit is available. Expenses related to or connected with the detection or correction by manual or mechanical means of structural imbalance, distortion or subluxation; where such care is for the purpose of removing nerve interference and its effects and where interference is the result of or related to distortion, misalignment or subluxation of or in the spinal column. Chiropractic Services and Supplies are limited by a number of visits indicated in the "Schedule of Benefits and Copayments - SELECT 2 and SELECT 3" sections.
Appears in 1 contract