term restorative occupational therapy, physical therapy and speech therapy. Skilled nursing care in a skilled nursing facility requires Preauthorization. Exclusions: Personal comfort items such as telephone and television; rest cures; domiciliary or Convalescent Care Sterilization FDA-approved female sterilization procedures, services and Hospital - Inpatient: No charge; Enrollee pays supplies. See Preventive Services for additional information. nothing Non-Emergency inpatient hospital services require Hospital - Outpatient: No charge; Enrollee pays Preauthorization. nothing Outpatient Services: No charge; Enrollee pays nothing Vasectomy. Hospital - Inpatient: No charge; Enrollee pays nothing Non-Emergency inpatient hospital services require Preauthorization. Hospital - Outpatient: No charge; Enrollee pays nothing Outpatient Services: No charge; Enrollee pays nothing Exclusions: Procedures and services to reverse a sterilization Substance Use Disorder Substance use disorder services including inpatient Hospital - Inpatient: After Deductible, Enrollee Residential Treatment; diagnostic evaluation and education; pays $150 Copayment per day up to $750 per organized individual and group counseling; and/or admission prescription drugs unless excluded under Sections IV. or V. Outpatient Services: After Deductible, Enrollee Substance use disorder means a substance-related or addictive pays $15 primary care provider services Copayment disorder listed in the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). For the Group Visits: No charge; Enrollee pays nothing purposes of this section, the definition of Medically Necessary shall be expanded to include those services necessary to treat a substance use disorder condition that is having a clinically significant impact on an Enrollee’s emotional, social, medical and/or occupational functioning. Substance use disorder services are limited to the services rendered by a physician (licensed under RCW 18.71 and RCW 18.57), a psychologist (licensed under RCW 18.83), a substance use disorder treatment program licensed for the service being provided by the Washington State Department of Social and Health Services (pursuant to RCW 70.96A), a PEBB_CRCOB_2024 40