 Treatment for temporomandibular joint (TMJ) disorder.  Urgent Care visits.  Vasectomy. Dental Anesthesia—Inpatient/Outpatient General anesthesia Services and related facility charges in conjunction with any dental procedure performed in a hospital are covered subject to the applicable inpatient/outpatient facility Cost Share if such anesthesia Services and related facility charges are Medically Necessary because the Member:  is a child under age seven, or is physically or developmentally disabled, with a dental condition that cannot be safely and effectively treated in a dental office; or  has a medical condition that the Member’s PCP or Participating Provider determines would place the Member at undue risk if the dental procedure were performed in a dental office. The procedure must be approved by the Member’s PCP or Participating Provider. For the purpose of this section, “general anesthesia Services” means Services to induce a state of unconsciousness accompanied by a loss of protective reflexes, including the ability to maintain an airway independently and respond purposefully to physical stimulation or verbal command. Nitrous oxide analgesia is not reimbursable as general anesthesia. 17. Interrupted Pregnancy Surgery We cover interrupted pregnancy surgery in an inpatient or outpatient setting. 18. Kaiser Permanente at Home™ Kaiser Permanente at Home is a personalized, patient-centered program that provides care in your home (or a place of temporary or permanent residence used as your home) as an alternative to receiving acute care in a hospital. Kaiser Permanente at Home Services must be associated with an acute medical condition, such as, but not limited to, congestive heart failure, pneumonia, cellulitis or upper urinary tract infection, and are subject to prior authorization from Company in accordance with Utilization Review criteria developed by Medical Group and approved by Company. To receive Kaiser Permanente at Home Services:  You must be referred into the program by a Participating Provider.  Your condition must meet criteria for Medically Necessary hospitalization.  A Medical Group physician determines that it is feasible to maintain effective supervision and control of your care in the home, and that based on your health status, treatment plan, and home setting, you can be treated safely and effectively in the home.  You must consent to receiving Kaiser Permanente at Home Services because you prefer to receive the care described in your treatment plan in your home.  The care location must be within 30 minutes of a 911 response.  The care location must have cell service. Services are provided or arranged by Kaiser Permanente and Medically Home. Medically Home is the Participating Provider we contract with to provide Services under this program, including:  Telemedical visits and in-person home visits by a care team of specialized health care providers including physicians, nurse practitioners, physician assistants, RNs, physical therapists, occupational therapists, EWCLGHDHP1983ACT0124 51 WAPEBB-CD-ACT