from KFHPWA Facilities (beyond the distance the Enrollee would normally be required to travel for most hospital services), are covered in accordance with the transplant benefit language, provided the Enrollee is accepted into the treating facility’s transplant program and continues to follow that program’s prescribed protocol. Organ Transplant Donor: The costs related to organ removal, as well as the cost of treating complications directly resulting from surgery, are covered, provided the organ recipient is an Enrollee under this Agreement, and provided the donor is not eligible for coverage under any other health care plan or government-funded program. Donor search costs for up to 15 searches only for allogeneic bone marrow transplants. Transplant services must be provided through locally and nationally contracted or approved transplant centers. All transplant services require Preauthorization. Contact Member Services for Preauthorization. Exclusions: Donor costs to the extent that they are reimbursable by the organ donor’s insurance; living expenses except as covered under Section II.K. Utilization Management; transportation expenses except as covered above; costs for searches for non-allogeneic bone marrow donors Urgent Care Inside the KFHPWA Service Area, urgent care is covered at a Network Emergency Department: After Kaiser Permanente medical center, Kaiser Permanente urgent Deductible, Enrollee pays 10% Plan Coinsurance care center or Network Provider’s office. Network Urgent Care Center: After Deductible, Outside the KFHPWA Service Area, urgent care is covered at Enrollee pays 10% Plan Coinsurance any medical facility. Network Provider’s Office: After Deductible, See Section XII. for a definition of Urgent Condition. Enrollee 10% Plan Coinsurance Non-Network Provider: After Deductible, Enrollee pays 10% Plan Coinsurance V. General Exclusions In addition to exclusions listed throughout the EOC, the following are not covered: 1. Benefits and related services, supplies and drugs that are not Medically Necessary for the treatment of an illness, injury, or physical disability, that are not specifically listed as covered in the EOC, except as required by federal or state law. 2. Services Related to Non-Covered Services: When a service is not covered, all services related to the non- covered service (except for the specific exceptions described below) are also excluded from coverage. Enrollees who have received a non-covered service, such as bariatric surgery, and develop an acute medical complication (such as band slippage, leak or infection) as a result, shall have coverage for Medically Necessary intervention PEBB HMOHSA 2024 45