2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 4: Medical Benefits Chart (what is covered and what you pay) 124 Services that are covered for you What you must pay when you get these services in-network and out-of-network care. For members with stage IV chronic kidney disease when referred by their doctor, we cover up to six sessions of kidney disease education services per lifetime. · Outpatient dialysis treatments (including dialysis $0 copayment for Medicare- covered benefits.†† treatments when temporarily out of the service area, as explained in Chapter 3, or when your provider for this service is temporarily unavailable or inaccessible) · Self-dialysis training (includes training for you and $0 copayment for Medicare- anyone helping you with your home dialysis treatments) covered benefits. · Inpatient dialysis treatments (if you are admitted as an These services will be covered inpatient to a hospital for special care) as described in the following sections: Please refer to Inpatient hospital care. · Home dialysis equipment and supplies Please refer to Durable medical equipment and related supplies. · Certain home support services (such as, when Please refer to Home health necessary, visits by trained dialysis workers to check on agency care. your home dialysis, to help in emergencies, and check your dialysis equipment and water supply) Certain drugs for dialysis are covered under your Medicare Part B drug benefit. For information about coverage for Part B Drugs, please go to the section, “Medicare Part B prescription drugs.”