been furnished, if the Non-Participating Provider determines that, taking into account your medical or behavioral health condition, you are not able to travel to an available Participating Provider within a reasonable travel distance, using non-medical transportation or non-emergency transportation. Employing Agency. A division, department, or separate agency of state government, including an institution of higher education; a county, municipality, or other political subdivision; and a tribal government covered by HCA statute. Enrollee. A person who is eligible and enrolled under this EOC, and for whom Kaiser has received applicable premium. This EOC sometimes refers to an Enrollee as “you” or “Member.” The term Enrollee may include the Subscriber, their Dependent, or other individual who is eligible for and enrolled under this EOC. Essential Health Benefits. Essential Health Benefits means benefits that the U.S. Department of Health and Human Services (HHS) Secretary defines as essential health benefits. Essential Health Benefits must be equal to the scope of benefits provided under a typical employer plan, except that they must include at least the following: ambulatory services, emergency services, hospitalization, maternity and newborn care, mental health and Substance Use Disorder services (including behavioral health treatment), prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services (including oral and vision care). External Prosthetic Devices. External prosthetic devices are rigid or semi-rigid external devices required to replace all or any part of a body organ or extremity, and designated by CMS in the “L codes” of the Healthcare Common Procedure Coding System. Family. A Subscriber and all of their enrolled Dependents. Family Planning Services. Those medical care Services related to planning the birth of children through the use of birth control methods, including elective sterilization. Formulary. A list of outpatient prescription drugs, selected by Kaiser and revised periodically, which are covered when prescribed by a Participating Provider and filled at a Participating Pharmacy. Gender Affirming Treatment. Medically Necessary Services that a Participating Provider prescribes, in accordance with generally accepted standards of care, to treat any condition related to a Member’s gender expression or gender identity. Group. Washington Public Employees Benefits Board (PEBB) Program. Health Care Authority (HCA). The Washington State Agency that administers the PEBB and SEBB Programs. Home Health Agency. A “home health agency” is an agency that: (i) meets any legal licensing required by the state or other locality in which it is located; (ii) qualifies as a participating home health agency under Medicare; and (iii) specializes in giving skilled nursing facility care Services and other therapeutic Services, such as physical therapy, in the patient’s home (or to a place of temporary or permanent residence used as your home). Homemaker Services. Assistance in personal care, maintenance of a safe and healthy environment, and Services to enable the individual to carry out the plan of care. Independent Freestanding Emergency Department. A health care facility that is geographically separate and distinct and licensed separately from a hospital under applicable State law and that provides Emergency Services. Kaiser. Kaiser Foundation Health Plan of the Northwest, an Oregon nonprofit corporation, who provides Services and benefits for Members enrolled in this Plan - Public Employees Benefits Board (PEBB) Program. This EOC sometimes refers to Kaiser as “we,” “our,” or “us.” EWCLGDED1983ACT0124 10 WAPEBB-CL-ACT