Ambulance Services Exclusions  Transportation by car, taxi, bus, gurney van, wheelchair van, minivan, and any other type of transportation (other than a licensed ambulance), even if it is the only way to travel to a Participating Facility or other location. 5. Bariatric Surgery and Weight Control and Obesity Treatment We cover bariatric surgery procedures and related pre-surgery and post-surgery Services for clinically severe obesity in adults, subject to Utilization Review by Kaiser using criteria developed by Medical Group and approved by Kaiser. The Member may request Utilization Review criteria, and a list of the approved surgical procedures we cover when criteria is met, by calling Member Services. In addition to Utilization Review, you must meet one of the following requirements:  The Member fully complies with the Kaiser Permanente Severe Obesity Evaluation and Management Program’s contract for participation approved by Kaiser; or,  The Member receives the Service at a facility accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). 6. Services Provided in Connection with Clinical Trials We cover Services you receive in connection with a clinical trial if all of the following conditions are met:  We would have covered the Services if they were not related to a clinical trial.  You are eligible to participate in the clinical trial according to the trial protocol with respect to treatment of cancer or other life-threatening condition (a condition from which the likelihood of death is probable unless the course of the condition is interrupted), as determined in one of the following ways: • A Participating Provider makes this determination. • You provide us with medical and scientific information establishing this determination. • If any Participating Providers participate in the clinical trial and will accept you as a participant in the clinical trial, you must participate in the clinical trial through a Participating Provider unless the clinical trial is outside the state where you live.  The clinical trial is a phase I, phase II, phase III, or phase IV clinical trial related to the prevention, detection, or treatment of cancer or other life-threatening condition and it meets one of the following requirements: • The study or investigation is conducted under an investigational new drug application reviewed by the U.S. Food and Drug Administration (FDA). • The study or investigation is a drug trial that is exempt from having an investigational new drug application. • The study or investigation is approved or funded by at least one of the following: o The National Institutes of Health. o The Centers for Disease Control and Prevention. o The Agency for Health Care Research and Quality. o The Centers for Medicare & Medicaid Services. o A cooperative group or center of any of the above entities or of the Department of Defense or the Department of Veterans Affairs. EWCLGDED1983ACT0124 41 WAPEBB-CL-ACT