4 2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage Table of Contents Section 2 — Use providers in our network to get your medical care .....................................40 Section 3 — How to get services when you have an emergency or urgent need for care or during a disaster ..........................................................................................................44 Section 4 — What if you are billed directly for the full cost of your services? .....................46 Section 5 — How are your medical services covered when you are in a clinical research study? ........................................................................................................................47 Section 6 — Rules for getting care in a religious nonmedical health care institution ............48 Section 7 — Rules for ownership of durable medical equipment ..........................................49 Section 8 — Rules for oxygen equipment, supplies, and maintenance ..................................50 Chapter 4 — Medical Benefits Chart (what is covered and what you pay) ............ 51 Section 1 — Understanding your out-of-pocket costs for covered services ..........................51 Section 2 — Use the Medical Benefits Chart at the front of this EOC to find out what is covered and how much you will pay ..................................................................................52 Section 3 — What services are not covered by our plan? ......................................................53 Chapter 5 — Asking us to pay our share of a bill you have received for covered medical services ................................................................. 60 Section 1 — Situations in which you should ask us to pay our share of the cost of your covered services .............................................................................................................60 Section 2 — How to ask us to pay you back or to pay a bill you have received ....................61 Section 3 — We will consider your request for payment and say yes or no ..........................62 Chapter 6 — Your rights and responsibilities .......................................................... 63 Section 1 — We must honor your rights and cultural sensitivities as a member of our plan .........................................................................................................................................63 Section 2 — You have some responsibilities as a member of our plan .................................68 Chapter 7 — What to do if you have a problem or complaint (coverage decisions, appeals, complaints) ....................................................... 69 Section 1 — Introduction ........................................................................................................69 kp.org