2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage 55 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 Custodial care • Custodial care is personal care that does not require the continuing attention Not covered under any of trained medical condition or paramedical personnel, such as care that helps you with activities of daily living, such as bathing or dressing. Elective or voluntary Covered if medically necessary and covered enhancement under Original Medicare. procedures or services (including weight loss, hair growth, sexual performance, athletic performance, cosmetic purposes, anti-aging, and mental performance) Experimental medical May be covered by Original Medicare and surgical under a Medicare-approved clinical procedures, research study. (See Chapter 3, Section 5, equipment, and for more information about clinical research medications studies.) • Experimental procedures and items are those items and procedures determined by our plan and Original Medicare to not be generally accepted by the medical community. 1-877-221-8221 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.