 Services provided solely for the comfort of the Member, except palliative care provided under the “Hospice Services” benefit.  Weight Control and Obesity Treatment. • Non-surgical: Any weight loss or weight control programs, treatments, services, or supplies, even when prescribed by a physician, including, but not limited to, prescription and over-the-counter drugs, exercise programs (formal or informal) and exercise equipment. Travel expenses associated with non-surgical or surgical weight control or obesity services are not covered. • Surgical: Surgery for dietary or weight control, and any direct or non-direct complications arising from such non-covered surgeries, whether prescribed or recommended by a physician, including surgeries such as: o Gastric banding (including adjustable gastric/lap banding and vertical banded gastroplasty). o Mini-gastric banding (gastric bypass using a Billroth II type of anastomosis). o Distal gastric bypass (long limb gastric bypass). o Biliopancreatic bypass and biliopancreatic with duodenal switch. o Jejunoileal bypass. o Gastric stapling or liposuction. o Removal of excess skin.  The surgical exclusion for weight control and obesity treatment will not apply to pre-authorized, Medically Necessary bariatric surgery for adult morbid obesity as specifically set forth in this EOC and the Kaiser Permanente Severe Obesity Evaluation and Management Program criteria. More than one bariatric surgery for you or your enrolled Dependents will not be covered under the PEBB Program.  Evaluation and treatment of learning disabilities, including dyslexia, except as provided for neurodevelopmental therapies.  Eye Surgery. Radial keratotomy, photorefractive keratectomy, and refractive surgery, including evaluations for the procedures.  Orthotics, except foot care appliances for prevention of complications associated with diabetes which are covered.  Services for which a Member has contractual right to recover cost under homeowner’s or other no-fault coverage, to the extent that it can be determined that the Member received double recovery for such services.  Non-Medically Necessary Services. Services that are not Medically Necessary.  Services Related to a Non-Covered Service. When a Service is not covered, all Services related to the non-covered Service are also excluded. However, this exclusion does not apply to Services we would otherwise cover if they are to treat complications which arise from the non-covered Service and to Medically Necessary Services for a Member enrolled in and participating in a qualifying clinical trial if we would typically cover those Services absent a clinical trial.  When Medicare coverage is primary, charges for Services provided to Members through a “private contract” agreement with a physician or practitioner who does not provide Services through the Medicare program.  Travel Immunizations. Travel-related immunizations for yellow fever, typhoid, and Japanese encephalitis. EWCLGDED1983ACT0124 74 WAPEBB-CL-ACT