Medical Supplies – 90%

Benefits are provided for the following items prescribed by a physician if the individual has an immediate medical need: sterile surgical dressings; casts; splints; surgical and orthopedic appliances; up to four pair of compression support stockings (e.g., Jobst) per calendar year; catheters; syringes; and formulas for the treatment of phenylketonuria.

Benefits are not provided for:

1. Supplies purchased or dispensed when a plan benefit is not in effect or when the individual is not covered under this plan.
2. Items purchased or used more frequently than considered reasonable by the plan.
3. Incontinence supplies, ear plugs, enemas, alcohol swabs, cotton balls or like supplies.
4. Freight, postage or delivery charges.

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