15. Hospice Services .................................................................................................................................................. 48 16. Hospital Services .................................................................................................................................................. 49 17. Interrupted Pregnancy Surgery .......................................................................................................................... 51 18. Kaiser Permanente at Home™ .......................................................................................................................... 51 19. Massage Therapy .................................................................................................................................................. 53 20. Medical Foods and Formula .............................................................................................................................. 53 21. Mental Health Services ........................................................................................................................................ 53 22. Naturopathic Medicine ....................................................................................................................................... 54 23. Obstetrics, Maternity and Newborn Care ........................................................................................................ 55 24. Office Visits .......................................................................................................................................................... 56 25. Organ Transplants ............................................................................................................................................... 56 26. Out-of-Area Coverage for Dependents............................................................................................................ 57 27. Outpatient Surgery Visit ..................................................................................................................................... 58 28. Prescription Drugs, Insulin, and Diabetic Supplies ........................................................................................ 58 29. Preventive Care Services ..................................................................................................................................... 64 30. Radiation and Chemotherapy Services ............................................................................................................. 66 31. Reconstructive Surgery Services ........................................................................................................................ 66 32. Rehabilitative Therapy Services ......................................................................................................................... 66 33. Skilled Nursing Facility Services ........................................................................................................................ 67 34. Spinal and Extremity Manipulation Therapy Services .................................................................................... 67 35. Substance Use Disorder Services ...................................................................................................................... 68 36. Telehealth Services............................................................................................................................................... 69 37. Temporomandibular Joint Dysfunction (TMJ) ............................................................................................... 70 38. Tobacco Use Cessation ....................................................................................................................................... 70 39. Vasectomy Services ............................................................................................................................................. 71 40. Vision Services for Adults .................................................................................................................................. 71 41. Vision Services for Children ............................................................................................................................... 72 Benefit Exclusions and Limitations .............................................................................. 73 Reductions ...................................................................................................................... 76 When the Member has Other Medical Coverage .................................................................................................. 76 Notice to Covered Persons ................................................................................................................................ 77 Definitions for this “When the Member has Other Medical Coverage” section: ...................................... 77 Order of Benefit Determination Rules ............................................................................................................ 78 Hospitalization on Your Effective Date ................................................................................................................. 81 When Another Party is Responsible for Injury or Illness (Subrogation) ........................................................... 81 Injuries or Illnesses Alleged to be Caused by Other Parties or Covered by No-fault Insurance ............ 81 Surrogacy Arrangements – Traditional and Gestational Carriers ....................................................................... 82 Workers’ Compensation or Employer’s Liability .................................................................................................. 83 Grievances, Claims, Appeals, and External Review ................................................... 83 EWCLGHDHP01983ACT0124 WAPEBB-CD-ACT