2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage 57 Chapter 4: Medical Benefits Chart (what is covered and what you pay) Services not Not covered under Covered only under specific covered by any condition conditions Medicare Physical exams and Covered if a network physician determines other services that the services are medically necessary or (1) required for medically appropriate preventive care. obtaining or maintaining employment or participation in employee programs, (2) required for insurance or licensing, or (3) on court order or required for parole or probation Private duty nursing Not covered under any condition Private room in a Covered when medically necessary. hospital Psychological testing Not covered under any for ability, aptitude, condition intelligence, or interest Radial keratotomy, Not covered under any LASIK surgery, and condition other low-vision aids Reconstructive We cover reconstructive surgery to correct surgery that offers or repair abnormal structures of the body only a minimal caused by congenital defect, developmental improvement in abnormalities, accidental injury, trauma, appearance or is infection, tumors, or disease, if a network performed to alter or physician determines that it is necessary to reshape normal improve function, or create a normal structures of the body appearance, to the extent possible. in order to improve appearance 1-877-221-8221 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.