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Nicotine gum or nicotine patches whether or not a prescription is required. These benefits are limited to a 90-day supply for each member in each calendar year.

One pair of therapeutic shoes each calendar year for a member with severe diabetic foot disease, including fitting and inserts.

Wigs for up to $500 each calendar year when hair loss is due to: chemotherapy; radiation therapy; and treatment of cancer or leukemia.

Note: These benefits for human organ and stem cell transplants are limited to in-network benefits.

Note: These benefits for human organ and stem cell transplants are limited to in-network benefits.

(These benefits may be reduced by any benefits that have already been provided for these covered services under a prior Blue Cross Blue Shield coverage in the same eligible time periods.)

(These benefits may be reduced by any benefits that have already been provided for these covered services under a prior Blue Cross Blue Shield non-HMO coverage in the same eligible time periods.)

(These benefits may be reduced by any benefits that have already been provided for these covered services under a prior Blue Cross Blue Shield HMO coverage in the same eligible time periods.)

These covered services also include one hearing aid for each ear (or one set of binaural hearing aids) up to the dollar amount described in the benefit limit. This includes dispensing fees, acquisition costs and repairs.

These covered services also include frames and/or prescription lenses (or contact lenses) up to the dollar amount described in the benefit limit.