PROSTHETIC APPLIANCES. Purchase, fitting, necessary adjustments, repairs, and replacements of prosthetic devices and supplies which replace all or part of an absent body organ (including contiguous tissue) or replace all or part of the function of a permanently inoperative or malfunctioning body organ (excluding dental appliances and the replacement of cataract lenses). Initial and subsequent prosthetic devices to replace the removed breast(s) or a portion thereof are also covered.
PROSTHETIC APPLIANCES. The Member’s initial provision and replacement of a prosthetic device that temporarily or permanently replaces all or part of an external body part lost or impaired as a result of disease or injury or congenital defects is covered, when such device is prescribed by a Participating Provider, administered through a Participating or designated prosthetic Provider and pre-authorized by HMO. Coverage includes repair and replacement when due to congenital growth. Instruction and appropriate services required for the Member to properly use the item (such as attachment or insertion) are covered. Covered prosthetic appliances include those items covered by Medicare unless excluded in the Exclusions and Limitations section of this Certificate. HMO reserves the right to provide the most cost efficient and least restrictive level of service or item which can be safely and effectively provided.
PROSTHETIC APPLIANCES when prescribed by a physician or surgeon and purchased within 52 weeks of the Accident, the Insurer will pay benefits incurred for artificial limbs and/or eyes up to the maximum stated in Appendix A for each Injury resulting in a loss requiring such an appliance. This does not include repairs, adjustments or replacements of same
PROSTHETIC APPLIANCES including the purchase, fitting, necessary adjustments, repairs and replacements of prosthetic devices and supplies which replace all or part of an absent body organ (including contiguous tissue) or replace all or part of the function of a permanently inoperative or malfunctioning body organ (excluding dental appliances and the replacement of cataract lenses); initial and subsequent prosthetic devices to replace the removed breast(s) or a portion thereof; the purchase, fitting, necessary adjustments, repairs and replacement of a rigid or semi-rigid supportive device which restricts or eliminates motion of a weak or diseased body part; and the rental (but not to exceed the total cost of purchase) or, at the option of the Plan, the purchase, adjustment, repairs and replacement of durable medical equipment when prescribed by a professional provider within the scope of their license and required for therapeutic use.
PROSTHETIC APPLIANCES. Purchase of the following items when authorized in writing by the patient's attending physician: standard type artificial limb or eye, splints, trusses, casts, cervical collars, braces (excluding dental braces), catheters, urinary kits, external breast prostheses (following mastectomies), ostomy supplies (where a surgical stoma exists) and corrective prosthetic lenses and frames (once only for persons who lack an organic lens or after cataract surgery). Custom-made orthopaedic boots or shoes, adjustments to stock item footwear and custom moulded foot orthoses (orthotics) are subject to a combined maximum of $500 per person per calendar year. This maximum does not apply to dependent children. Surgical stockings with a compression factor greater than or equal to 25mmg to a maximum of six (6) pairs per calendar year. The purchase of a cystistat kit will be considered an eligible expense when the attending physician, outlining the diagnosis and recommended course of treatment, completes a pre-authorization. The patient will be re-evaluated after the eighth treatment and additional pre-authorization must be obtained if further treatment is required. This benefit is limited to one course of treatment.
PROSTHETIC APPLIANCES. The Company will pay fifty percent (50%) of the cost of Prosthetic Appliances, excluding such appliances intended for cosmetic purposes, as required by employees or their covered dependants.
PROSTHETIC APPLIANCES. Purchase of the following items when authorized in writing by the patient's attending physician: standard type artificial limb or eye, repairs to prosthetic appliances, xxxxx socks, splints, trusses, casts, cervical collars, braces (excluding dental braces), catheters, urinary kits, external breast prostheses (following mastectomies), surgical brassieres (following mastectomies), ostomy supplies (where a surgical stoma exists), tracheotomy, and corrective prosthetic lenses and frames (once only for persons who lack an organic lens or after cataract surgery). Lymphedema sleeves/compression sleeves with a mean compression factor or 20mmHG, up to a maximum of 2 sleeves per body part of limb per calendar year, Wigs and hairpieces for patients with temporary hair loss as a result of medical treatment, up to a maximum of $1,500 per lifetime. Custom-made orthopaedic boots or shoes, adjustments to stock item footwear and custom moulded foot orthoses (orthotics) are subject to a combined maximum of $500 per person per calendar year for adults. For dependent children two (2) pairs per calendar year (no dollar limitation for dependent children only). Surgical stockings with a compression factor greater than or equal to 25mmHG to a maximum of six (6) pairs per calendar year. The purchase of a cystistat kit will be considered an eligible expense when the attending physician, outlining the diagnosis and recommended course of treatment, completes a pre-authorization. The patient will be re-evaluated after the eighth treatment and additional pre-authorization must be obtained if further treatment is required. This benefit is limited to one course of treatment.
PROSTHETIC APPLIANCES. Purchase of the following items when authorized in writing by the patient's attending physician: standard type artificial limb or eye, repairs to prosthetic appliances, xxxxx socks, surgical stockings up to a maximum of $400 per calendar year, splints, trusses, casts, cervical collars, braces (excluding dental braces), catheters, urinary kits, external breast prostheses (following mastectomies), surgical brassieres, incontinence supplies, ostomy supplies (where a surgical stoma exists), tracheotomy supplies and corrective prosthetic lenses and frames (once only for persons who lack an organic lens or after cataract surgery). Lymphedema sleeves/compression sleeves with a mean compression factor of 20mmHG, up to a maximum of 2 sleeves per body part or limb per calendar year. Wigs and hairpieces for patients with temporary hair loss, up to a maximum of $1,500 per lifetime. Custom-made orthopedic boots or shoes, adjustments t o stock item footwear and custom molded foot orthoses (orthotics) are subject to a combined maximum of $500 per employee per calendar year and $750 per 2 calendar years for spouse and dependent children. The purchase of a cystistat kit will be considered an eligible expense when a pre-authorization is completed by the attending physician, outlining the diagnosis and recommended course of treatment. The patient will be re-evaluated after the eighth treatment and additional preauthorization must be obtained if further treatment is required. This benefit is limited to one course of treatment.
PROSTHETIC APPLIANCES. Purchase of the following items when authorized in writing by the patient’s attending physician: standard type artificial limb or eye, splints, trusses, casts, cervical collars, braces (excluding dental braces), catheters, urinary kits, external breast prostheses (following mastectomies), ostomy supplies (where a surgical stoma exists) and corrective prosthetic lenses and frames (once only for persons who lack an organic lens or after cataract surgery). Custom-made orthopaedic boots or shoes, adjustments to stock item footwear and custom moulded foot orthoses (orthotics) are subject to a combined maximum of $500 per person per calendar year. This maximum does not apply to dependent children. The purchase of a cystistat kit will be considered an eligible expense when a pre- authorization is completed by the attending physician, outlining the diagnosis and recommended course of treatment. The patient will be re-evaluated after the eighth treatment and additional pre-authorization must be obtained if further treatment is required. This benefit is limited to one course of treatment.
PROSTHETIC APPLIANCES. Purchase of the following items when authorized in writing by the patient’s attending physician: standard type artificial limb or eye; splints; trusses; casts; cervical collars; braces (excluding dental braces); internal catheters; urinary kits; external breast prostheses (following mastectomies); 2 pairs of surgical brassieres following a mastectomy; surgical stockings for relief and control of varicose veins or following surgery on the legs; wigs (following chemotherapy, to a lifetime maximum of $70); ostomy supplies (where a surgical stoma exists); lancets; corrective prosthetic lenses and frames (once only for purposes who lack an organic lens or after cataract surgery); custom-made orthopedic boots or shoes or adjustments to a stock item footwear, custom molded foot orthoses (orthodics), up to a combined maximum of $500 per employee or spouse per calendar year, and as required for dependent children. Surgical stockings with a compression factor greater than or equal to 25mmg to a maximum of six (6) pairs per calendar year.
