2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage 49 Chapter 3: Using our plan for your medical services Section 6.2 – Receiving care from a religious nonmedical health care institution To get care from a religious nonmedical health care institution, you must sign a legal document that says you are conscientiously opposed to getting medical treatment that is non-excepted. • Non-excepted medical care or treatment is any medical care or treatment that is voluntary and not required by any federal, state, or local law. • Excepted medical treatment is medical care or treatment that you get that is not voluntary or is required under federal, state, or local law. To be covered by our plan, the care you get from a religious nonmedical health care institution must meet the following conditions: • The facility providing the care must be certified by Medicare. • Our plan's coverage of services you receive is limited to nonreligious aspects of care. • If you get services from this institution that are provided to you in a facility, the following conditions apply: ♦ You must have a medical condition that would allow you to receive covered services for inpatient hospital care or skilled nursing facility care. ♦ – and – you must get approval in advance from our plan before you are admitted to the facility, or your stay will not be covered. Note: Covered services are subject to the same limitations and cost-sharing required for services provided by network providers as described in Chapter 4, the Medical Benefits Chart found at the front of the EOC, and Chapter 10. Section 7 — Rules for ownership of durable medical equipment Section 7.1 – Will you own the durable medical equipment after making a certain number of payments under our plan? Durable medical equipment (DME) includes items such as oxygen equipment and supplies, wheelchairs, walkers, powered mattress systems, crutches, diabetic supplies, speech-generating devices, IV infusion pumps, nebulizers, and hospital beds ordered by a provider for use in the home. The member always owns certain items, such as prosthetics. In this section, we discuss other types of DME that you must rent. In Original Medicare, people who rent certain types of DME own the equipment after paying copayments for the item for 13 months. As a member of our plan, however, you will not acquire ownership of rented DME items no matter how many copayments you make for the item while a member of our plan, even if you made up to 12 consecutive payments for the DME item under Original Medicare before you joined our plan. What happens to payments you made for durable medical equipment if you switch to Original Medicare? If you did not acquire ownership of the DME item while in our plan, you will have to make 13 new consecutive payments after you switch to Original Medicare in order to own the item. The payments made while enrolled in your plan do not count. 1-877-221-8221 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.