Laboratory and Radiology ............................................................................................................................. 28 Manipulative Therapy ................................................................................................................................... 28 Massage Therapy ........................................................................................................................................... 28 Maternity and Pregnancy ............................................................................................................................... 29 Mental Health and Wellness .......................................................................................................................... 29 Naturopathy ................................................................................................................................................... 31 Newborn Services ......................................................................................................................................... 31 Nutritional Counseling .................................................................................................................................. 31 Nutritional Therapy ....................................................................................................................................... 31 Obesity Related Surgical Services................................................................................................................. 32 On the Job Injuries or Illnesses ..................................................................................................................... 32 Oncology ....................................................................................................................................................... 33 Optical (vision) .............................................................................................................................................. 33 Oral Surgery .................................................................................................................................................. 35 Outpatient Services ....................................................................................................................................... 35 Plastic and Reconstructive Surgery ............................................................................................................... 35 Podiatry ......................................................................................................................................................... 36 Preventive Services ....................................................................................................................................... 36 Rehabilitation and Habilitative Care (occupational, physical and speech therapy, pulmonary and cardiac rehabilitation) and Neurodevelopmental Therapy .................................................................................. 37 Reproductive Health ...................................................................................................................................... 38 Sexual Dysfunction ....................................................................................................................................... 39 Skilled Nursing Facility................................................................................................................................. 39 Sterilization ................................................................................................................................................... 40 Substance Use Disorder................................................................................................................................. 40 Telehealth Services ....................................................................................................................................... 42 Temporomandibular Joint (TMJ) .................................................................................................................. 43 Tobacco Cessation ......................................................................................................................................... 43 Transplants .................................................................................................................................................... 43 Urgent Care ................................................................................................................................................... 44 V. General Exclusions ...................................................................................................................................... 45 VI. Eligibility, Enrollment and Termination ................................................................................................... 46 A. Eligibility for subscribers and dependents ............................................................................................. 47 B. Enrollment for subscribers and dependents ............................................................................................ 48 C. Medicare eligibility and enrollment ....................................................................................................... 50 D. When medical coverage begins .............................................................................................................. 51 E. Making changes ..................................................................................................................................... 52 F. When medical coverage ends ................................................................................................................. 57 G. General provisions for eligibility and enrollment .................................................................................. 59 H. Appeal rights .......................................................................................................................................... 59 I. Relationship to law and regulations ....................................................................................................... 59 J. PEBB customer service .......................................................................................................................... 60 VII. Grievances .................................................................................................................................................... 60 VIII. Appeals ......................................................................................................................................................... 60 IX. Claims ........................................................................................................................................................... 62 X. Coordination of Benefits ............................................................................................................................. 62 PEBB_CRCOB_2024 4