 It is certified by Medicare as a transplant facility for the specific transplant.  It is designated by Kaiser as a transplant facility for the specific transplant.  It is able to meet reasonable access standards for organ transplants based on Regional Organ Procurement Agency statistics for the facility location (a Regional Organ Procurement Agency is the geographic area designated by a state-licensed organ procurement organization for transplants in the state of Washington). Organ transplant recipient. If a Member is accepted into a Participating Facility’s transplant program and continues to follow that program’s prescribed protocol, all organ transplant Services for the Member receiving the organ are covered according to the transplant benefit protocol. This includes transportation to and from a Participating Facility (beyond that distance the Member would normally be required to travel for most hospital Services). Organ transplant donor. Kaiser provides (or pays for) certain donation-related Services for a living transplant donor, or an individual identified by Medical Group as a potential donor, even if the donor is not a Member. These Services must be directly related to a covered transplant for a Member. Kaiser’s criteria for donor Services are available by calling Member Services. Organ Transplants Limitations  If either Medical Group or the referral facility determines that you do not satisfy its respective criteria for a transplant, we will only cover Services you receive before that determination is made.  Kaiser, Participating Hospitals, Medical Group, and Participating Providers are not responsible for finding, furnishing, or ensuring the availability of an organ, tissue, or bone marrow donor.  We may pay certain expenses that we preauthorize in accord with our travel and lodging guidelines. Your transplant coordinator can provide information about covered expenses. Organ Transplants Exclusions  Non-human organs and their implantation. 26. Out-of-Area Coverage for Dependents This limited out-of-area benefit is available to Dependent children who are outside any Kaiser Foundation Health Plan service area. We cover certain Medically Necessary Services that a Dependent child receives from Non-Participating Providers outside any Kaiser Foundation Health Plan service area but inside the United States (which for the purpose of this benefit means the 50 states, the District of Columbia, and United States territories). These out-of-area benefits are limited to the following Services as otherwise covered under this EOC. Any other Services not specifically listed as covered are excluded under this out-of-area benefit.  Office visits are limited to preventive care, primary care, specialty care, outpatient physical therapy visits, outpatient mental health and Substance Use Disorder Services, naturopathic medicine Services, and allergy injections – limited to ten visits combined per Year.  Laboratory and diagnostic X-rays – limited to ten visits per Year. This benefit does not include special diagnostic procedures such as CT, MRI, or PET scans.  Prescription drug fills – limited to ten fills per Year. You pay the Cost Share as shown in the “Benefit Summary” under the “Out-of-Area Coverage for Dependents” section. EWCLGDED1983ACT0124 56 WAPEBB-CL-ACT