Infant Formulas Sample Clauses

Infant Formulas. The Plan provides Benefits for Medically Necessary amino acid-based elemental Infant Formula for Members two years of age or younger, without regard to the method of delivery of the formula. Coverage will be provided under this section when a Physician Provider has documented that the amino acid-based elemental infant formula is Medically Necessary. Health Options may require that a Provider confirm and document at least annually that the formula remains Medically Necessary. The cost-sharing for formula is treated as Durable Medical Equipment for purposes of the Schedule of Benefits.
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