When equipment and supplies can be purchased at a pharmacy: This Program provides benefits for Prescription Drugs (other than coverage for insulin and oral agents only): Certain Diabetic Equipment and Supplies, including insulin and oral agents, may be purchased at a pharmacy, if available; This will be subject to the cost-sharing arrangements, applicable to the prescription drug coverage. When equipment is not available at a pharmacy: The equipment will be provided under the Durable Medical Equipment benefit. This will be subject to the cost-sharing arrangements applicable to Durable Medical Equipment. Covered Diabetic Equipment: Blood glucose monitors; Insulin pumps; Insulin infusion devices; and Orthotics and podiatric appliances for the prevention of complications associated with diabetes. Covered Diabetic Supplies: Blood testing strips; Lancets and lancet devices; Visual reading and urine test strips; Monitor supplies; Insulin and insulin analogs; Pharmacological agents for controlling Injection aids; blood sugar levels*; and Insulin syringes; Glucagon emergency kits. * Note: If this Program does not provide coverage for prescription insulin and oral agents are covered as provided under the "Insulin and Oral Agents" benefits. Diagnostic Services The Claims Administrator will provide coverage for the following Diagnostic Services, when ordered by a Participating Professional Provider; and billed by a Referred Specialist, and/or a Participating Facility Provider: Routine Diagnostic Services, including: Routine radiology: Consisting of x-rays, ultrasound, and nuclear medicine; Routine medical procedures: Consisting of ECG, EEG, Nuclear Cardiology Imaging and other diagnostic medical procedures approved by the Claims Administrator; and Allergy testing: Consisting of percutaneous, intracutaneous and tests. Non-Routine Diagnostic Services, including: Operative and diagnostic endoscopies; MRI/MRA; CT Scans, and PET Scans. Diagnostic laboratory and pathology Genetic testing and counseling. This includes services provided to a Member at risk for a specific disease that is a result of: Family history; or Exposure to environmental factors that are known to cause physical or mental disorders. When clinical usefulness of specific genetic tests has been established by the Claims Administrator, these services are covered for the purpose of: Diagnosis; Screening;
When equipment and supplies can be purchased at a pharmacy: This Program provides benefits for Prescription Drugs (other than coverage for insulin and oral agents only): Certain Diabetic Equipment and Supplies, including insulin and oral agents, may be purchased at a pharmacy, if available; This will be subject to the cost-sharing arrangements, applicable to the prescription drug coverage. When equipment is not available at a pharmacy: The equipment will be provided under the Durable Medical Equipment benefit. This will be subject to the cost-sharing arrangements applicable to Durable Medical Equipment. Covered Diabetic Equipment: Blood glucose monitors; Insulin pumps; Insulin infusion devices; and Orthotics and podiatric appliances for the prevention of complications associated with diabetes. Covered Diabetic Supplies: Blood testing strips; Lancets and lancet devices; Visual reading and urine test strips; Monitor supplies; Insulin and insulin analogs; Pharmacological agents for controlling Injection aids; blood sugar levels*; and Insulin syringes; Glucagon emergency kits. * Note: If this Program does not provide coverage for prescription insulin and oral agents are covered as provided under the "Insulin and Oral Agents" benefits. Diagnostic Services The Claims Administrator will provide coverage for the following Diagnostic Services, when ordered by a Participating Professional Provider; and billed by a Referred Specialist, and/or a Participating Facility Provider: Routine Diagnostic Services, including: Routine radiology: Consisting of x-rays, ultrasound, and nuclear medicine; Routine medical procedures: Consisting of ECG, EEG, Nuclear Cardiology Imaging and other diagnostic medical procedures approved by the Claims Administrator; and Allergy testing: Consisting of percutaneous, intracutaneous and tests. Non-Routine Diagnostic Services, including: Operative and diagnostic endoscopies; MRI/MRA; CT Scans, and PET Scans. Diagnostic laboratory and pathology Genetic testing and counseling. This includes services provided to a Member at risk for a specific disease that is a result of: Family history; or Exposure to environmental factors that are known to cause physical or mental disorders. When clinical usefulness of specific genetic tests has been established by the Claims Administrator, these services are covered for the purpose of: Diagnosis; Screening;