2023 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
Orthopedic and Prosthetic Devices
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Orthopedic and Prosthetic Devices
Note: We state whether or not the calendar year deductible applies for each benefit listed in this section.
Benefit Description
Orthopedic and Prosthetic Devices
Orthopedic braces and prosthetic appliances such as:
Note: A prosthetic appliance is a device that is surgically inserted or physically attached to the body to restore a bodily function or replace a physical portion of the body.
We provide hospital benefits for internal prosthetic devices, such as artificial joints, pacemakers, cochlear implants, and surgically implanted breast implants following mastectomy; see Section 5(c) for payment information. Insertion of the device is paid as surgery; see Section 5(b).
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Benefit Description
Orthopedic and Prosthetic Devices
Orthopedic braces and prosthetic appliances such as:
- Artificial limbs and eyes
- Functional foot orthotics when prescribed by a physician
- Rigid devices attached to the foot or a brace, or placed in a shoe
- Replacement, repair, and adjustment of covered devices
- Following a mastectomy, breast prostheses and surgical bras, including necessary replacements
- Surgically implanted penile prostheses limited to treatment of erectile dysfunction or as part of an approved plan for gender affirming surgery
- Surgical implants
Note: A prosthetic appliance is a device that is surgically inserted or physically attached to the body to restore a bodily function or replace a physical portion of the body.
We provide hospital benefits for internal prosthetic devices, such as artificial joints, pacemakers, cochlear implants, and surgically implanted breast implants following mastectomy; see Section 5(c) for payment information. Insertion of the device is paid as surgery; see Section 5(b).
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Benefit Description
Not covered:
You Pay
All charges
Not covered:
- Shoes (including diabetic shoes)
- Over-the-counter orthotics
- Arch supports
- Heel pads and heel cups
- Wigs (including cranial prostheses)
- Hearing aids, including bone anchored hearing aids, accessories or supplies (including remote controls and warranty packages) and all associated services
You Pay
All charges