Durable medical equipment (DME), supplies, and prostheses TIP: The plan pays for covered DME at the standard rate. To receive the highest benefit, you must get the equipment or supply from a preferred DME supplier or other preferred medical provider. To find preferred DME providers, see the “Finding a preferred DME supplier” section below. You pay the standard rate for covered DME services and supplies if they are prescribed by a provider practicing within their scope of practice, medically necessary, and used to treat a covered condition, including, but not limited to: • Artificial limbs or eyes (including implant lenses prescribed by a physician and required due to cataract surgery or to replace a missing portion of the eye). • Automatic Positive Airway Pressure (APAP) devices and related supplies. • Bi-level Positive Airway Pressure (BiPAP) devices and related supplies. • Bone growth (osteogenic) stimulators. • Breast prostheses and bras as required by mastectomy. See the “Mastectomy and breast reconstruction” benefit. • Breast pumps for pregnant and nursing members (see “Services covered as preventive” on page 64). • Casts, splints, crutches, trusses, and braces. • Compression stockings. • Continuous Positive Airway Pressure (CPAP) devices and related supplies. • Diabetic shoes, only as prescribed for a diagnosis of diabetes. See the “Foot orthotics” section below. • Elemental formulas for Eosinophilic Gastrointestinal Disorders (EGIDs). • Insulin pumps and related pump supplies (see the “Insulin pumps and related pump supplies” section below). • Ostomy supplies. • Oxygen and its equipment, such as all types of concentrators and tanks for administration, are covered on a rental basis only. • Penile prosthesis when other accepted treatment has been unsuccessful and impotence is: ▪ Caused by a covered medical condition; or ▪ A complication directly resulting from a covered surgery; or ▪ A result of an injury to the genitalia or spinal cord. • Rental or purchase (at the plan’s discretion) of DME such as wheelchairs, hospital beds, and respiratory equipment. (The combined rental fees cannot exceed full purchase price.) • Wig or hairpiece to replace hair loss due to radiation therapy or chemotherapy for a covered condition, up to a lifetime maximum of $100. Wigs and hairpieces for any other reason are not covered. Some items require preauthorization. Find the list of supplies that require a preauthorization by visiting forms and publications at hca.wa.gov/ump-forms-pubs and search “durable medical equipment” or contact UMP Customer Service. 48 2024 UMP Classic (PEBB) Certificate of Coverage