• The first two business days of inpatient or residential Services. • The first three business days of withdrawal management Services. Additional Services require prior authorization as described under “Prior and Concurrent Authorization and Utilization Review” in the “How to Obtain Services” section. Outpatient Services for Substance Use Disorder We cover individual office visits and group therapy visits for Substance Use Disorder. We cover in-home Substance Use Disorder Services, when all of the following are true:  You are substantially confined to your home (or a friend’s or relative’s home), or the care is provided in lieu of Medically Necessary hospitalization.  Your Participating Provider determines that it is feasible to maintain effective supervision and control of your care in your home and that the Services can be safely and effectively provided in your home.  You receive prior authorization from Kaiser in accordance with Utilization Review criteria developed by Medical Group and approved by Kaiser. Inpatient Hospital Services for Substance Use Disorder We cover inpatient hospital Services for Substance Use Disorder, including drugs that are prescribed as part of your plan of care and administered to you by medical personnel in the inpatient facility. When the Member is not yet enrolled in a dependency treatment program, Medically Necessary detoxification is covered as a medical Emergency Service. Residential Services We cover residential Services in a residential program, including drugs that are prescribed as part of your plan of care and administered to you by medical personnel in the residential facility. Day Treatment Services We cover day treatment Services in a day treatment program. 36. Telehealth Services Telemedicine Telemedicine is the delivery of health care services through use of real-time interactive audio and video communication, or store and forward technology, allowing a Member, or person acting on the Member’s behalf, to interact with a Participating Provider who is not physically at the same location, for the purpose of diagnosis, consultation, or treatment. Telemedicine does not include fax, email, voicemail, or text messages. Store and forward technology means sending a Member’s medical information from an originating site to the health care provider at a distant site for later review. The provider follows up with a medical diagnosis for the Member and helps manage their care. Store and forward technology does not include use of audio-only telephone, fax, or email. Audio-only telemedicine is the delivery of health care services through the use of audio-only technology, allowing a Member, or person acting on the Member’s behalf, to interact real-time with a Participating Provider who is not physically at the same location, for the purpose of diagnosis, consultation, or treatment. Audio-only telemedicine does not include fax or email, or health care Services that are customarily delivered by audio-only technology such as sharing of laboratory results. We cover telemedicine Services at the applicable telemedicine Cost Share shown in your “Benefit Summary” if: EWCLGHDHP1983ACT0124 69 WAPEBB-CD-ACT