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HSA Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 750 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 1250 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

The following orthotics may be covered:

  • Ankle-Foot Orthosis (AFO) and Knee-Ankle-Foot Orthosis (KAFO)
  • Cast Boot, Post-Operative Sandal or Shoe, or Healing Shoe
  • Cranial Orthoses
  • Elastic Supports
  • Footwear Incorporated into a Brace for Members with Skeletally Mature Feet
  • Foot Orthoses
  • Helmets
  • Hip Orthosis
  • Knee Orthosis
  • Orthopedic Footwear for Diabetic Members
  • Orthotic-Related Supplies
  • Spinal Orthoses
  • Trusses
  • Upper Limb Orthosis

For detailed coverage information, contact your medical plan provider.

Orthotic Device Replacement

When repairing an item that is no longer cost-effective and is out of warranty, the plan will consider replacing the item subject to review of medical necessity and life expectancy of the device.


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