2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 4: Medical Benefits Chart (what is covered and what you pay) 132 Services not covered by Not covered under any Covered only under specific Medicare condition conditions Full-time nursing care in your Not covered under any home. condition Custodial care. Not covered under any condition Custodial care is personal care that does not require the continuing attention of trained medical or paramedical personnel, such as care that helps you with activities of daily living, such as bathing or dressing. Homemaker services including Not covered under any basic household assistance, condition such as light housekeeping or light meal preparation. Fees charged for care by your Not covered under any immediate relatives or members condition of your household. Cosmetic surgery or Covered in cases of an procedures. accidental injury or for improvement of the functioning of a malformed body member. Covered for all stages of reconstruction for a breast after a mastectomy, as well as for the unaffected breast to produce a symmetrical appearance. Chiropractic services Manual manipulation of the (Medicare-covered) spine to correct a subluxation is covered. Excluded from Medicare coverage is any service other than manual manipulation of the spine for the treatment of subluxation.