8 2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage Medical Benefits Chart Services that are covered for you What you must pay when you get these services can special order it for you. The most recent list of suppliers is available on our website at kp.org/directory. We also cover the following DME not covered by Medicare when medically necessary: • Bed accessories when bed extension is required. • Iontophoresis device to treat hyperhidrosis when antiperspirants are contraindicated and the hyperhidrosis has created medical complications or is preventing daily living activities. • Resuscitation bag if tracheostomy patient has significant secretion management problems, needing lavage and suction technique aided by deep breathing via resuscitation bag. Emergency care $50 per Emergency Department visit Emergency care refers to services that are: This copayment does not apply if you • Furnished by a provider qualified to furnish emergency are immediately admitted directly to the services, and hospital as an inpatient (it does apply if • Needed to evaluate or stabilize an emergency medical you are admitted to the hospital as an condition. outpatient; for example, if you are A medical emergency is when you, or any other prudent admitted for observation). layperson with an average knowledge of health and medicine, †If you receive emergency care at an believe that you have medical symptoms that require out-of-network hospital and need immediate medical attention to prevent loss of life (and, if inpatient care after your emergency you are a pregnant woman, loss of an unborn child), loss of a condition is stabilized, you must return limb, or loss of function of a limb. The medical symptoms to a network hospital in order for your may be an illness, injury, severe pain, or a medical condition care to continue to be covered or you that is quickly getting worse. must have your inpatient care at the out- Cost-sharing for necessary emergency services furnished out- of-network hospital authorized by our of-network is the same as for such services furnished in- plan and your cost is the cost-sharing network. you would pay at a network hospital. You have worldwide emergency care coverage. Fitness benefit (the Silver&Fit® Healthy Aging and Exercise Program) $0 The Silver&Fit program includes the following: • You can join a participating Silver&Fit fitness center and take advantage of the services that are included in the † 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. kp.org