Out-of-Pocket Maximum. The total amount of Copayments, Coinsurance and Deductible you will be responsible to pay in a Year, as described in the “Out-of-Pocket Maximum” section of this EOC. Participating Facility. Any facility listed as a Participating Facility in the Medical Facility Directory. Participating Facilities are subject to change. Participating Hospital. Any hospital listed as a Participating Hospital in the Medical Facility Directory. Participating Hospitals are subject to change. Participating Medical Office. Any outpatient treatment facility listed as a Participating Medical Office in the Medical Facility Directory. Participating Medical Offices are subject to change. Participating Pharmacy. A pharmacy owned and operated by Kaiser Permanente or another pharmacy that we designate that is listed as a Participating Pharmacy in the Medical Facility Directory. Participating Pharmacies are subject to change. Participating Physician. Any licensed physician who is an employee of the Medical Group, or contracts directly or indirectly with Medical Group. Participating Physicians are subject to change. Participating Provider. Any person who is a Participating Physician; or a physician or other health care provider, facility, business, or vendor regulated under state law to provide health or health-related services or otherwise providing health care services within the scope of licensure or certification consistent with state law and which contracts directly or indirectly with Kaiser to provide Services to Members enrolled in this Plan. Participating Providers are subject to change. Participating Skilled Nursing Facility. A facility that provides inpatient skilled nursing Services, rehabilitation Services, or other related health Services and is licensed by the state of Oregon or Washington and approved by Kaiser. The facility’s primary business must be the provision of 24-hour-a-day licensed skilled nursing care. The term “Participating Skilled Nursing Facility” does not include a convalescent nursing home, rest facility, or facility for the aged that furnishes primarily custodial care, including training in routines of daily living. A “Participating Skilled Nursing Facility” may also be a unit or section within another facility (for example, a Participating Hospital) as long as it continues to meet the definition above. Participating Skilled Nursing Facilities are subject to change. Patient Protection and Affordable Care Act of 2010. Means the Patient Protection and Affordable Care Act of 2010 (Public Law 11 148) as amended by the Health Care and Education Reconciliation Act of 2010 ‐ (Public Law 111 152). ‐ Plan. The Public Employee Benefits Board (PEBB) Program health benefit plan of coverage agreed to between PEBB and Kaiser Foundation Health Plan of the Northwest (Kaiser). In the eligibility sections “plan” may mean a plan other than Kaiser not sponsored by the PEBB Program. Post-Stabilization Care. The Services you receive for the acute episode of your Emergency Medical Condition after your treating physician determines that your Emergency Medical Condition is clinically stable. (“Clinically stable” means that no material deterioration of the Emergency Medical Condition is likely, within reasonable medical probability, to result from or occur during your discharge or transfer from the hospital.) Premium. Monthly membership charges paid by Group. Primary Care Provider (PCP). A Participating Provider who provides, prescribes, or directs all phases of a Member’s care, including appropriate referrals to Non-Participating Providers. The PCP has the responsibility for supervising, coordinating, and providing primary health care to Members, initiating referrals for Specialist care, and maintaining the continuity of Member care. PCPs, as designated by Medical Group, may include, but are not limited to, Pediatricians, Family Practitioners, General Practitioners, Internists, Physician’s Assistant (under the supervision of a physician), or Advanced Registered Nurse Practitioners (ARNP). EWCLGDED1983ACT0124 12 WAPEBB-CL-ACT