The SUBlue, SUOrange and SUPro medical plan options provide support for people with newly diagnosed diabetes as well those who have been managing this chronic condition for many years.
Diabetic Self-Management Education: if you have been newly diagnosed with diabetes, or if your physician has diagnosed a significant change in your symptoms or your condition, you can receive education about self-management techniques and diet instruction. These educational services can be provided by your physician or nurse practitioner during a regular office visit, or by a certified diabetes educator, nutritionist or registered dietician with a referral from your physician. Your cost for each visit is determined by the plan option (SUBlue, SUOrange or SUPro).
Diabetic Supplies and Equipment: Coverage is available through both the medical benefit (administered by POMCO) and the prescription drug benefit (administered by OptumRx). You may want to use benefits under each option to secure the supplies and equipment you need to manage your condition at the lowest out-of-pocket cost.
- Through Medical Benefit (POMCO): diabetic supplies and equipment such as insulin pumps, glucose meters (including continuous blood glucose monitor transmitters), test strips, and syringes are covered when purchased from a network provider of durable medical equipment (limited coverage may be available for out-of-network providers). A prescription from your physician is required.
- Through Prescription Drug Benefit (OptumRx): insulin, insulin pumps and related supplies, non-insulin diabetic medications (e.g., metformin), blood glucose meters, diabetic supplies (lancets, lancing devices, alcohol swabs, test strips), insulin syringes and injecting devices (pens) are covered subject to the formulary listing of preferred drugs. The formulary currently covers OneTouch® products at Tier 2 (preferred); other brands are excluded.
- Free OneTouch glucose meter: to order a OneTouch system at no charge, visit onetouch.orderpoints.com and input order code 594PRX100, or call 1-866-355-9962.
Routine Foot Care is covered only for patients with severe systemic disorders. Foot orthotics are covered if medically necessary.
Routine Eye Exams are covered through the medical plan at the member cost share for your plan option. If you are enrolled in the VSP Vision Care Plan, coverage is available for exams and prescription lenses (glasses or contacts), with additional benefits through the Diabetic Eyecare Plus Program. Ask your participating VSP provider to evaluate whether these benefits are appropriate for your ophthalmological condition.
The SUBlue, SUOrange and SUPro medical plan options also provide Nutrition Counseling and Nutrition Therapy; for details, please see below.
Nutritional Counseling: The plan will cover nutritional wellness counseling for adults with risk factors, and for adults and children diagnosed with obesity. Services must be provided by a physician, certified nutritionist or certified and registered dietician. There is no copay for these visits with a participating network provider, up to a maximum of 26 visits per covered person per calendar year.
Nutritional Therapy: The plan will cover up to 8 visits per calendar year for nutritional therapy with a registered or certified dietician. Your cost for each visit is determined by the plan option (SUBlue, SUOrange, or SUPro).
Weight Loss Surgery is covered for people with a diagnosis of morbid obesity, subject to medical guidelines.
Questions about the above information? Please Contact POMCO Member Services toll-free at 877.461.7844