Per type of prostheses
Breast Prostheses
Every calendar year (January to December), you and your dependants each have a maximum of $400 per breast towards the purchase of breast prostheses, including an additional $200 maximum per year for mastectomy bras.
Exclusion(s):
Eye Prostheses
Based on a rolling 3-year period, you and your dependants each have a maximum of $2,110 towards the purchase and/or repair of eye prostheses.
Larynx Prostheses
Based on a rolling 3-year period, you and your dependants each have a maximum of $2,000 towards the purchase and/or repair of larynx prostheses.
Limb Prostheses
Based on a rolling 3-year period, you and your dependants each have a combined maximum of $15,000 per limb towards the purchase, repair and/or replacement of prosthetic limbs, myoelectric limbs and stockings.
Exclusion(s):
Adults are restricted to no more than one replacement per limb on a rolling 3-year period. Dependants under the age of 18 are still subject to the $15,000 per limb maximum but are covered for more than one prosthesis per limb.
If you are an Early Retiree or MyRetiree Plan member, your annual Premium Statement and Claim Summary will be available in your My ASEBP account, under the Documents tab, no later than February 28.
