ria/pdf/gender_reassignment_surgery.pdf for details. Outpatient Services: Enrollee pays $20 Copayment Prescription drugs are covered the same as for any other for primary care provider office visits condition (see Drugs – Outpatient Prescription for coverage) After Deductible, Enrollee pays 15% Plan Counseling services are covered the same as for any other Coinsurance for specialty care provider office visits condition (see Mental Health and wellness for coverage). Non-Emergency inpatient hospital services require Preauthorization. Exclusions: Cosmetic services and surgery not related to gender affirming treatment (i.e., face lift or calf implants); complications of non-Covered Services Hearing Examinations and Hearing Aids Hearing exams for hearing loss and evaluation are covered Hospital - Inpatient: After Deductible, Enrollee only when provided at KFHPWA-approved facilities. pays $500 Copayment per admission Cochlear implants and surgically implanted Bone Anchored Hospital - Outpatient: After Deductible, Enrollee Hearing System (BAHS) when in accordance with KFHPWA pays 15% Plan Coinsurance clinical criteria. Outpatient Services: Enrollee pays $20 Copayment Covered services for initial cochlear implants and surgically for primary care provider office visits implanted BAHS include diagnostic testing, pre-implant testing, implant surgery, post-implant follow-up, speech After Deductible, Enrollee pays 15% Plan therapy, programming and associated supplies (such as Coinsurance for specialty care provider office visits transmitter cable, and batteries). Replacement devices and associated supplies – see Devices, Equipment and Supplies Section. Hearing, externally worn bone conduction hearing devices, Enrollee pays nothing, limited to an Allowance of and non-surgical Bone Anchored Hearing System (BAHS) for $3,000 maximum per ear during any consecutive 36- hearing loss. month period After Allowance: Not covered; Enrollee pays 100% of all charges Initial assessment, fitting, adjustments, auditory training and Outpatient Services: Enrollee pays $20 Copayment ear molds as necessary to maintain optimal fit. for primary care provider office visits After Deductible, Enrollee pays 15% Plan Coinsurance for specialty care provider office visits Exclusions: Programs or treatments for hearing loss or hearing care associated with externally worn hearing or surgically implanted hearing aids and the surgery and services necessary to implant them except as described above; hearing screening tests required under Preventive Services; replacement costs of hearing aids due to loss, breakage or theft, unless at the time of such replacement the Enrollee is eligible under the benefit Allowance; replacement parts; replacement batteries; maintenance costs PEBB_SCA_2024 25