 Internally implanted insulin pumps.  Repair or replacement of External Prosthetic Devices and Orthotic Devices due to loss or misuse. 11. Emergency Services Emergency department visits at an emergency room facility are covered. If the Member is transferred from the emergency room to an observation bed, there is no additional Cost Share. If the Member is admitted as an inpatient directly from the emergency room or from an observation bed, the inpatient hospital Cost Share will be applied. Use of a hospital emergency room for a non-medical emergency is not covered. 12. Habilitative Services We cover inpatient and outpatient habilitative Services subject to Utilization Review by Kaiser using criteria developed by Medical Group and approved by Kaiser. Coverage includes the range of Medically Necessary Services or health care devices designed to help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These Services may include physical, occupational, speech, and aural therapy, and other Services for people with disabilities and that:  Takes into account the unique needs of the individual.  Targets measurable, specific treatment goals appropriate for the person’s age, and physical and mental condition. We cover these habilitative Services at the Cost Share shown in the “Benefit Summary.” The “Benefit Summary” also shows a visit maximum for habilitative Services. That visit maximum will be exhausted (used up) for a Year when the number of visits that we covered during the Year under this EOC, plus any visits we covered during the Year under any other evidence of coverage with the same group number printed on this EOC, add up to the visit maximum. After you reach the visit maximum, we will not cover any more visits for the remainder of the Year. Visit maximums do not apply to habilitative Services to treat mental health conditions covered under this EOC. The following habilitative Services are covered as described under the “Durable Medical Equipment (DME) and External Prosthetic Devices and Orthotic Devices” section:  Braces, splints, prostheses, orthopedic appliances and Orthotic Devices, supplies or apparatuses used to support, align or correct deformities or to improve the function of moving parts.  Durable Medical Equipment and mobility enhancing equipment used to serve a medical purpose, including sales tax. Habilitative Services Exclusions  Activities that provide diversion or general motivation.  Custodial care or services for individualized education program development.  Daycare.  Exercise programs for healthy individuals.  Housing.  Recreational activities.  Respite care.  Services and devices delivered pursuant to federal Individuals with Disabilities Education Act of 2004 (IDEA) requirements. EWCLGHDHP1983ACT0124 46 WAPEBB-CD-ACT