2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Complete (PPO) Chapter 4: Medical Benefits Chart (what is covered and what you pay) 96 Services that are covered for you What you must pay when you get these services in-network and out-of-network · Hepatitis B vaccine if you are at high or intermediate other Medicare-covered risk of getting Hepatitis B immunizations. · COVID-19 vaccine · Other vaccines if you are at risk and they meet Medicare Part B coverage rules We also cover some vaccines under our Part D prescription drug benefit, such as shingles or tetanus booster shots. See Chapter 6 for more information about coverage and applicable cost-sharing. Inpatient hospital care $0 copayment for each Includes inpatient acute, inpatient rehabilitation, long-term Medicare-covered hospital stay each time you are admitted.†† care hospitals, and other types of inpatient hospital services. Inpatient hospital care starts the day you are formally Medicare hospital benefit admitted to the hospital with a doctor’s order. The day periods do not apply. (See before you are discharged is your last inpatient day. definition of benefit periods in Covered services include, but are not limited to: the chapter titled Definitions of · Semi-private room (or a private room if medically important words.) For inpatient necessary) hospital care, the cost-sharing described above applies each · Meals including special diets time you are admitted to the · Regular nursing services hospital. A transfer to a · Costs of special care units (such as intensive care or separate facility type (such as coronary care units) an Inpatient Rehabilitation · Drugs and medications Hospital or Long Term Care Hospital) is considered a new · Lab tests admission. For each inpatient · X-rays and other radiology services hospital stay, you are covered · Necessary surgical and medical supplies for unlimited days as long as · Use of appliances, such as wheelchairs the hospital stay is covered in accordance with plan rules. · Operating and recovery room costs · Physical, occupational, and speech language therapy