AI Content Chat (Beta) logo

 Travel and Lodging. Transportation or living expenses for any person, including the patient, are limited to travel and lodging expenses needed for the Member to receive covered Services at Non-Participating Facilities, subject to Utilization Review by Kaiser using criteria developed by Medical Group and approved by Kaiser.  Services That are Not Health Care Services, Supplies, or Items. This exclusion does not apply to Medically Necessary applied behavior analysis (ABA) Services. For example, we do not cover: • Teaching manners and etiquette. • Teaching and support services to develop planning skills such as daily activity planning and project or task planning. • Items and services that increase academic knowledge or skills. • Teaching and support services to increase intelligence. • Academic coaching or tutoring for skills such as grammar, math, and time management. • Teaching you how to read, whether or not you have dyslexia. • Educational testing. • Teaching art, dance, horse riding, music, play or swimming. • Teaching skills for employment or vocational purposes. • Vocational training or teaching vocational skills. • Professional growth courses. • Training for a specific job or employment counseling. • Recreation therapy. • Aquatic therapy and other water therapy.  Designated Blood Donations. Collection, processing, and storage of blood donated by donors whom you designate, and procurement and storage of cord blood is covered only when Medically Necessary for the imminent use at the time of collection for a designated recipient.  Detained or Confined Members. Services provided or arranged by criminal justice officials or institutions for detained or confined Members are limited to Services which meet the requirements of Emergency Services under this EOC.  Employer Responsibility. We do not reimburse the employer for any Services that the law requires an employer to provide. When we cover any of these Services we may recover the Charges for the Services from the employer.  Government Agency Responsibility. We do not reimburse the government agency for any Services that the law requires be provided only by or received only from a government agency. When we cover any of these Services, we may recover the Charges for the Services from the government agency.  Nonreusable Medical Supplies. Nonreusable medical supplies, such as splints, slings, and wound dressing, including bandages and ace wrap bandages, are limited to those supplied and applied by a licensed health care provider, while providing a covered Service. Nonreusable medical supplies that a Member purchases or obtains from another source are excluded. EWCLGDED1983ACT0124 75 WAPEBB-CL-ACT

Kaiser Permanente NW Classic EOC (2024) - Page 82 Kaiser Permanente NW Classic EOC (2024) Page 81 Page 83