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General Coverage Scope of Coverage Level of Coverage Diabetic Supplies and Equipment Coverage includes insulin, blood glucose monitors, blood glucose monitors for visually impaired, data management systems, test strips for monitors and visual reading, urine test strips, insulin, injection aids, cartridges for visually impaired, syringes, insulin pumps and appurtenances thereto, insulin infusion devices, oral agents. As prescribed by a physician or other licensed health care provider legally authorized to prescribe under title eight of the education law. Diabetic Education and Home Visits Diabetes self-management education (including diet); reeducation or refresher. Home visits for diabetic monitoring and/or education. Limited to visits medically necessary where a physician diagnoses a significant change in the patient’s symptoms or conditions which necessitate changes in a patient’s self-management or where reeducation is necessary. May be provided by a physician or other licensed health care provider legally authorized to prescribe under title eight of the education law, or their staff, as part of an office visit for diabetes diagnosis or treatment, or by a certified diabetes nurse educator, certified diagnosis nutritionist, certified dietician or registered dietician upon the referral of a physician or other licensed health care provider legally authorized to prescribe under title eight of the education law and may be limited to group settings wherever practicable. Emergency, Preventive and Routine Vision Care Vision examinations performed by a physician, or optometrist for the purpose of determining the need for corrective lenses, and if needed, to provide a prescription. The vision examination may include, but is not limited to:  Case history  Internal and External examination of the eye  Opthalmoscopic exam  Determination of refractive status  Binocular balance  Tonometry tests for glaucoma  Gross visual fields and color vision testing  Summary findings and recommendations for corrective lenses Prescribed Lenses At a minimum, quality standard prescription lenses provided by a physician, optometrist or optician are to be covered once in any twelve month period, unless required more frequently with appropriate documentation. The lenses may be glass or plastic lenses. Frames At a minimum, standard frames adequate to hold lenses will be covered once in any twelve month period, unless required more frequently with appropriate documentation.

If medically warranted, more than one pair of glasses will be covered. Contact Lenses

Covered when medically necessary. Emergency, Preventive and Emergency Dental Care Includes emergency treatment required to alleviate pain and suffering caused by dental disease or trauma.