Outpatient Services: After Deductible, Enrollee pays 10% Plan Coinsurance Exclusions: Obesity treatment and treatment for morbid obesity for any reason including any medical services, drugs, supplies regardless of co-morbidities, except as described above; specialty treatment programs such as weight control self-help programs or memberships, such as Weight Watchers, Jenny Craig or other such programs; medications and related physician visits for medication monitoring On the Job Injuries or Illnesses On the job injuries or illnesses. Office of Worker’s Compensation Programs (OWCP) or similar Federal or State agency pays through a third-party settlement: Not covered; Enrollee pays 100% of all charges After the third-party settlement maximum is paid: Hospital - Inpatient: After Deductible, Enrollee pays 10% Plan Coinsurance Hospital - Outpatient: After Deductible, Enrollee pays 10% Plan Coinsurance Outpatient Services: After Deductible, Enrollee pays 10% Plan Coinsurance Exclusions: Confinement, treatment or service that results from an illness or injury arising out of or in the course of any employment for wage or profit including injuries, illnesses or conditions incurred as a result of self-employment; Services needed because of a workplace-related illness or injury that the Office of Workers’ Compensation Programs (OWCP) or a similar Federal or State agency determines they must provide; or OWCP or a similar agency pays for through a third party injury settlement or other similar proceeding that is based on a claim you filed under OWCP or similar laws Oncology Radiation therapy, chemotherapy, oral chemotherapy. Radiation Therapy and Chemotherapy: After Deductible, Enrollee pays 10% Plan See Infusion Therapy for infused medications. Coinsurance Oral Chemotherapy Drugs: Preferred generic drugs (Tier 1): After Deductible, Enrollee pays $20 Copayment per 30-days up to a 90-day supply Preferred brand name drugs (Tier 2): After Deductible, Enrollee pays $40 Copayment per 30- days up to a 90-day supply Non-Preferred generic and brand name drugs (Tier 3): After Deductible, Enrollee pays 50% coinsurance up to $250 maximum per prescription PEBB HMOHSA 2024 33