18. Kaiser Permanente at Home™ ......................................................................................................................... 50 19. Massage Therapy ................................................................................................................................................. 52 20. Medical Foods and Formula ............................................................................................................................. 52 21. Mental Health Services ....................................................................................................................................... 52 22. Naturopathic Medicine ...................................................................................................................................... 54 23. Obstetrics, Maternity and Newborn Care ....................................................................................................... 54 24. Office Visits ......................................................................................................................................................... 55 25. Organ Transplants .............................................................................................................................................. 55 26. Out-of-Area Coverage for Dependents........................................................................................................... 56 27. Outpatient Surgery Visit .................................................................................................................................... 57 28. Prescription Drugs, Insulin, and Diabetic Supplies ....................................................................................... 57 29. Preventive Care Services .................................................................................................................................... 63 30. Radiation and Chemotherapy Services ............................................................................................................ 65 31. Reconstructive Surgery Services ....................................................................................................................... 65 32. Rehabilitative Therapy Services ........................................................................................................................ 65 33. Skilled Nursing Facility Services ....................................................................................................................... 66 34. Spinal and Extremity Manipulation Therapy Services ................................................................................... 67 35. Substance Use Disorder Services ..................................................................................................................... 67 36. Telehealth Services.............................................................................................................................................. 68 37. Temporomandibular Joint Dysfunction (TMJ) .............................................................................................. 69 38. Tobacco Use Cessation ...................................................................................................................................... 69 39. Vasectomy Services ............................................................................................................................................ 70 40. Vision Services for Adults ................................................................................................................................. 70 41. Vision Services for Children .............................................................................................................................. 71 Benefit Exclusions and Limitations............................................................................. 73 Reductions ..................................................................................................................... 76 When the Member has Other Medical Coverage ................................................................................................. 76 Notice to Covered Persons ............................................................................................................................... 76 Definitions for this “When the Member has Other Medical Coverage” section: ..................................... 76 Order of Benefit Determination Rules ........................................................................................................... 78 Hospitalization on Your Effective Date ................................................................................................................ 80 When Another Party is Responsible for Injury or Illness (Subrogation) .......................................................... 80 Injuries or Illnesses Alleged to be Caused by Other Parties or Covered by No-fault Insurance ........... 80 Surrogacy Arrangements – Traditional and Gestational Carriers ...................................................................... 81 Workers’ Compensation or Employer’s Liability ................................................................................................. 82 Grievances, Claims, Appeals, and External Review .................................................. 83 Language and Translation Assistance ..................................................................................................................... 84 Sharing Additional Information That We Collect ................................................................................................ 85 Internal Claims and Appeals Procedures ............................................................................................................... 85 EWCLGDED1983ACT0124 WAPEBB-CL-ACT