Blue Choice HMO Benefits - Harford County Public Schools

5. Include devices necessary for post-operative healing.
I. Prosthetic Device means a device which:
9.5 Covered Services.
1. Is primarily intended to replace all or part of an organ or body part that has been
lost due to disease or injury; or
2. Is primarily intended to replace all or part of an organ or body part that was
absent from birth; or
3. Is intended to anatomically replace all or part of a bodily function which is
permanently inoperative or malfunctioning; and
4. Is prescribed by a Health Care Provider; and
5. Is removable and attached externally to the body.
A. Durable Medical Equipment
Rental, or, (at CareFirst BlueChoice’s option), purchase and replacements or repairs of
Medically Necessary Durable Medical Equipment prescribed by a Health Care Provider
for therapeutic use for a Member’s medical condition.
Durable Medical Equipment or supplies associated or used in conjunction with Medically
Necessary Medical Foods and nutritional substances.
CareFirst BlueChoice’s payment for rental will not exceed the total cost of purchase.
CareFirst BlueChoice’s payment is limited to the least expensive Medically Necessary
Durable Medical Equipment, adequate to meet the Member’s medical needs. CareFirst
BlueChoice’s payment for Durable Medical Equipment includes related charges for
handling, delivery, mailing and shipping, and taxes.
B. Hair Prosthesis. Subject to limitations, if any, stated in the Schedule of Benefits,
benefits are available for a hair prosthesis when prescribed by a treating oncologist and
the hair loss is a result of chemotherapy or radiation treatment for cancer.
C. Medical Foods and Low Protein Modified Food Products
Medical Foods and Low Protein Modified Food Products for the treatment of Inherited
Metabolic Diseases if the Medical Foods or Low Protein Modified Food Products are:
1. Prescribed as Medically Necessary for the therapeutic treatment of Inherited
Metabolic Diseases; and;
2. Administered under the direction of a physician.
Coverage for Medical Foods and Nutritional Substances. Medically Necessary
medical foods and nutritional therapy for the treatment of disorders when ordered and
supervised by a Health Care Provider qualified to provide the diagnosis and treatment in
the field of the disorder/disease, as determined by CareFirst BlueChoice.
D. Medical Supplies
MD/GHMSI/CFMI BC (R. 10/10)
CareFirst BlueChoice
Harford County Public Schools 32 7/1/2011