2) The written protocol(s) or other document(s) pursuant to which the service has been or will be provided. 3) Any consent document(s) the Enrollee or Enrollee’s representative has executed or will be asked to execute, to receive the service. 4) The files and records of the Institutional Review Board (IRB) or similar body that approves or reviews research at the institution where the service has been or will be provided, and other information concerning the authority or actions of the IRB or similar body. 5) The published authoritative medical or scientific literature regarding the service, as applied to the Enrollee’s illness or injury. 6) Regulations, records, applications and any other documents or actions issued by, filed with or taken by, the FDA or other agencies within the United States Department of Health and Human Services, or any state agency performing similar functions. Appeals regarding KFHPWA denial of coverage can be submitted to the Member Appeal Department, or to KFHPWA's medical director at P.O. Box 34593, Seattle, WA 98124-1593. 10. Hypnotherapy and all services related to hypnotherapy. 11. Directed umbilical cord blood donations. 12. Prognostic (predictive) genetic testing and related services, unless specifically provided in Section IV. Testing for non- Enrollees. 13. Autopsy and associated expenses. 14. Over-the-counter items such as hearing aids unless specifically listed as covered in Section IV. 15. Academic/career counseling, counseling for overeating, work/school ordered assessments, relationship counseling, custodial care 16. Court-ordered or forensic treatment, including reports and summaries, not considered Medically Necessary. PEBB HMOHSA 2024 47