2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 51
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 51
Benefit Description
Durable Medical Equipment (DME)
Durable medical equipment (DME) is equipment and supplies that are:
We cover rental or purchase of durable medical equipment, at our option, including repair and adjustment. Covered items include:
Note: We cover DME at Preferred benefit levels only when you use a Preferred DME provider. Preferred physicians, facilities, and pharmacies are not necessarily Preferred DME providers.
*Prior approval required
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Durable Medical Equipment (DME)
Durable medical equipment (DME) is equipment and supplies that are:
- Prescribed by your attending physician (i.e., the physician who is treating your illness or injury);
- Medically necessary;
- Primarily and customarily used only for a medical purpose;
- Generally useful only to a person with an illness or injury;
- Designed for prolonged use; and
- Used to serve a specific therapeutic purpose in the treatment of an illness or injury.
We cover rental or purchase of durable medical equipment, at our option, including repair and adjustment. Covered items include:
- Home dialysis equipment
- Oxygen equipment
- Hospital beds
- Wheelchairs
- Crutches
- Walkers
- Continuous passive motion (CPM) devices
- Dynamic orthotic cranioplasty (DOC) devices
- Insulin pumps
- Other items that we determine to be DME, such as compression stockings
- Specialty DME* to include:
- Specialty hospital beds
- Deluxe wheelchairs, power wheelchairs and mobility devices including scooters and related supplies.
- Specialty hospital beds
Note: We cover DME at Preferred benefit levels only when you use a Preferred DME provider. Preferred physicians, facilities, and pharmacies are not necessarily Preferred DME providers.
*Prior approval required
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Benefit Description
You Pay
Any amount over $625 per year (no deductible)
- Speech-generating devices, limited to $625 per calendar year
You Pay
Any amount over $625 per year (no deductible)
Benefit Description
Not covered:
You Pay
All charges
Not covered:
- Exercise and bathroom equipment
- Vehicle modifications, replacements, or upgrades
- Home modifications, upgrades, or additions
- Lifts, such as seat, chair, or van lifts
- Car seats
- Diabetic supplies, except as described in Section 5(f) or when Medicare Part B is primary
- Air conditioners, humidifiers, dehumidifiers, and purifiers
- Breast pumps, except as previously described
You Pay
All charges