112 2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage Chapter 10: Definitions of important words Public Employees Benefits Board (PEBB) – A group of representatives, appointed by the governor, who approves insurance benefit plans for employees and their dependents, and establishes eligibility criteria for participation in insurance benefit plans. Public Employees Benefits Board (PEBB) Program – HCA program that administers PEBB benefit eligibility and enrollment. Quality Improvement Organization (QIO) – A group of practicing doctors and other health care experts paid by the federal government to check and improve the care given to Medicare patients. Rehabilitation Services – These services include physical therapy, speech and language therapy, and occupational therapy. School Employees Benefits Board (SEBB) – A group of representatives, appointed by the governor, who designs and approves insurance benefit plans for school employees and their dependents, and establishes eligibility criteria for participation in insurance benefit plans. School Employees Benefits Board (SEBB) Organization – A public school district or educational service district or charter school established under Washington state statute that is required to participate in benefit plans provided by the School Employees Benefits Board (SEBB). School Employees Benefits Board (SEBB) Program – Program within HCA that administers insurance and other benefits for eligible school employees and eligible dependents. Service Area – A geographic area where you must live to join a particular health plan. For plans that limit which doctors and hospitals you may use, it's also generally the area where you can get routine (nonemergency) services. Our plan must disenroll you if you permanently move out of your plan's service area. Services – Health care services, supplies, or items. Skilled Nursing Facility (SNF) Care – Skilled nursing care and rehabilitation services provided on a continuous, daily basis, in a skilled nursing facility. Examples of care include physical therapy or intravenous injections that can only be given by a registered nurse or doctor. Special Needs Plan – A special type of Medicare Advantage Plan that provides more focused health care for specific groups of people, such as those who have both Medicare and Medicaid, who reside in a nursing home, or who have certain chronic medical conditions. Subscriber – A member who has been determined eligible for membership on their own behalf and not by virtue of dependent status , is enrolled in this plan, and is the individual to whom the PEBB Program or this plan will issue notices, information, requests, and premium bills on behalf of an enrollee (for subscriber eligibility requirements, see Chapter 1, Section 2). Supplemental Security Income (SSI) – A monthly benefit paid by Social Security to people with limited income and resources who are disabled, blind, or age 65 and older. SSI benefits are not the same as Social Security benefits. Urgently Needed Services – Covered services that are not emergency services, provided when the network providers are temporarily unavailable or inaccessible or when the enrollee is out of the service area. For example, you need immediate care during the weekend. Services must be immediately needed and medically necessary. kp.org