network facility. For more information about balance billing protections, please visit: https://healthy.kaiserpermanente.org/washington/support/forms and click on the “Billing forms” link. Annual Open A period of time defined by HCA when a Subscriber may change to another health plan Enrollment offered by the PEBB Program and make certain other account changes for an effective date beginning January 1 of the following year. Continuation Coverage Temporary continuation of PEBB benefits available to Enrollees under the Consolidated Omnibus Budget Reconciliation Act (COBRA), the Uniformed Services Employment and Reemployment Rights Act (USERRA), or PEBB policies. Convalescent Care Care furnished for the purpose of meeting non-medically necessary personal needs which could be provided by persons without professional skills or training, such as assistance in walking, dressing, bathing, eating, preparation of special diets, and taking medication. Copayment The specific dollar amount a Enrollee is required to pay at the time of service for certain Covered Services. Cost Share The portion of the cost of Covered Services for which the Enrollee is liable. Cost Share includes Copayments, coinsurances and Deductibles. Covered Services The services for which an Enrollee is entitled to coverage in the EOC. Creditable Coverage Coverage is creditable if the actuarial value of the coverage equals or exceeds the actuarial value of standard Medicare prescription drug coverage, as demonstrated through the use of generally accepted actuarial principles and in accordance with CMS actuarial guidelines. In general, the actuarial determination measures whether the expected amount of paid claims under KFHPWA’s prescription drug coverage is at least as much as the expected amount of paid claims under the standard Medicare prescription drug benefit. Deductible A specific amount an Enrollee is required to pay for certain Covered Services before benefits are payable. Dependent Any member of a Subscriber's family who meets all applicable eligibility requirements as described in the “Dependent Eligibility” section of this EOC, is enrolled hereunder and for whom the premium has been paid. Emergency The emergent and acute onset of a medical, mental health or substance use disorder symptom or symptoms, including but not limited to severe pain or emotional distress, that would lead a prudent layperson acting reasonably to believe that a health condition exists that requires immediate medical attention, if failure to provide medical attention would result in serious impairment to bodily function or serious dysfunction of a bodily organ or part, or would place the Enrollee’s health, or if the Enrollee is pregnant, the health of the unborn child, in serious jeopardy, or any other situations which would be considered an emergency under applicable federal or state law. A division, department, or separate agency of state government, including an institution Employing Agency of higher education; a county, municipality, or other political subdivision; and a tribal government covered by HCA statute. Enrollee Any enrolled Subscriber or Dependent. PEBB HMOHSA 2024 71