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Orthopedic Shoes / Custom Orthotics

Orthopedic shoes and custom orthotics are specialized footwear and inserts designed to support proper alignment, relieve pain, and improve mobility for individuals with foot, leg, or posture-related conditions. These items are often prescribed to correct biomechanical issues, provide additional cushioning, or accommodate deformities caused by medical conditions such as arthritis, diabetes, or plantar fasciitis.

Most health insurance plans classify orthopedic shoes and orthotics as eligible medical equipment or supplies under extended health benefits. Coverage usually includes a set dollar maximum per year or every two benefit years and typically requires a prescription from a physician, podiatrist, or chiropodist. The policy may also specify that orthotics must be custom-made from a three-dimensional cast or scan of the foot to qualify for reimbursement.

Proper footwear and orthotics can significantly improve comfort and prevent secondary injuries by providing individualized support and promoting better body mechanics.

Example:

If your plan covers 80 percent of eligible expenses up to $400 every two years and your custom orthotics cost $500, your insurer reimburses $400 and you pay $100.

What to Watch For:

Ensure that your provider is recognized by your insurer and that the devices are custom-made rather than off-the-shelf. Some plans require itemized receipts, proof of casting, and pre-authorization. Replacement frequency limits and maximums may differ between orthotics and orthopedic shoes.

Related Terms

Occupational Class

Occupational class is the category assigned to an individual based on the type of work they perform and the level of risk associated with their job. Insurers use occupational classes to help determine eligibility, premium rates, and benefit levels for life, disability, and accident insurance. The classification reflects how likely a person is to experience injury, illness, or death related to their occupation.

Optional Benefit / Rider / Add-On

An optional benefit, also called a rider or add-on, is an additional feature that can be purchased to enhance your existing health, dental, life, or disability insurance plan. Optional benefits allow you to customize coverage by adding protection that suits your personal needs, rather than relying only on the base plan design.

Oral Surgery

Oral surgery refers to surgical procedures performed in or around the mouth and jaw by a licensed dentist, oral surgeon, or maxillofacial specialist. It includes both minor procedures, such as tooth extractions, and more complex surgeries involving the jawbone, soft tissue, or dental implants.

Orthodontics

Orthodontics covers the cost of correcting tooth alignment and jaw positioning using braces or aligners. In individual and group dental plans, orthodontic benefits are usually separate from preventive and restorative coverage. Most plans apply a lifetime maximum and a waiting period before orthodontic treatment is eligible.

Overall Plan Maximum

An overall plan maximum is the total amount your health and dental plan will pay for all combined benefits within a single policy year. Once the limit is reached, you must pay any additional expenses out of pocket until the next renewal period.

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