2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 4: Medical Benefits Chart (what is covered and what you pay) 136 Services not covered by Not covered under any Covered only under specific Medicare condition conditions For transplants: items not Not covered under any covered include, but are not condition limited to the below. For transportation: · Vehicle rental, purchase, or maintenance/repairs · Auto clubs (roadside assistance) · Gas · Travel by air or ground ambulance (may be covered under your medical benefit). · Air or ground travel not related to medical appointments · Parking fees incurred other than at lodging or hospital For lodging: · Deposits · Utilities (if billed separate from the rent payment) · Phone calls, newspapers, movie rentals and gift cards · Expenses for lodging when staying with a relative or friend · Meals Personal emergency response As specifically described as a system (PERS) covered service in the medical benefits chart in this chapter. Rally Coach™ programs As specifically described as a covered service in the medical benefits chart in this chapter. UnitedHealthcare Healthy at As specifically described as a Home post-discharge program covered service in the medical benefits chart in this chapter.