2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage 11 Medical Benefits Chart Services that are covered for you What you must pay when you get these services • For women who are pregnant, we cover up to three screening exams during a pregnancy. Home-based palliative care† Services not covered by Medicare in the home are provided in the form of palliative care to diminish symptoms of $0 terminally ill members with a life expectancy of 7–12 months. Services include non-Medicare-covered palliative nursing and social work services in the home. Home health agency care† Prior to receiving home health services, a doctor must certify that you need home health services and will order home health services to be provided by a home health agency. You $0 must be homebound, which means leaving home is a major Note: There is no cost-sharing for home effort. health care services and items provided Covered services include, but are not limited to: in accord with Medicare guidelines. • Part-time or intermittent skilled nursing and home health However, the applicable cost-sharing aide services (to be covered under the home health care listed elsewhere in this Medical Benefits benefit, your skilled nursing and home health aide services Chart will apply if the item is covered combined must total fewer than 8 hours per day and under a different benefit; for example, 35 hours per week). durable medical equipment not provided • Physical therapy, occupational therapy, and speech by a home health agency. therapy. • Medical and social services. • Medical equipment and supplies. Home infusion therapy† Home infusion therapy involves the intravenous or subcutaneous administration of drugs or biologicals to an $0 for professional services, training, individual at home. The components needed to perform home and monitoring. The components (such infusion include the drug (for example, antivirals, immune as, Medicare Part B drugs, DME, and globulin), equipment (for example, a pump), and supplies medical supplies) needed to perform (for example, tubing and catheters). home infusion may be subject to the Covered services include, but are not limited to: applicable cost-sharing listed elsewhere • Professional services, including nursing services, furnished in this Medical Benefits Chart in accordance with the plan of care. depending on the item. • Patient training and education not otherwise covered under the durable medical equipment benefit. † Your provider must obtain prior authorization from our plan. * Your cost-sharing for these services or items doesn't apply toward the maximum out-of-pocket amount. 1-877-221-8221 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.