devices, and non-surgical Bone Anchored Hearing System $3,000 maximum per ear during any consecutive 36- (BAHS) for hearing loss. month period After Allowance: Not covered; Enrollee pays 100% of all charges Initial assessment, fitting, adjustments, auditory training and Outpatient Services: After Deductible, Enrollee ear molds as necessary to maintain optimal fit. pays $15 primary care provider services Copayment or $30 specialty care provider services Copayment Exclusions: Programs or treatments for hearing loss or hearing care including, but not limited to, externally worn hearing or surgically implanted hearing aids and the surgery and services necessary to implant them except as described above; hearing screening tests required under Preventive Services; replacement costs of hearing aids due to loss, breakage or theft, unless at the time of such replacement the Enrollee is eligible under the benefit Allowance; repairs; replacement parts; replacement batteries; maintenance costs Home Health Care Home health care when the following criteria are met: No charge; Enrollee pays nothing • Except for patients receiving palliative care services, the Enrollee must be unable to leave home due to a health problem or illness. Unwillingness to travel and/or arrange for transportation does not constitute inability to leave the home. • The Enrollee requires intermittent skilled home health care, as described below. • KFHPWA’s medical director determines that such services are Medically Necessary and are most appropriately rendered in the Enrollee’s home. Covered Services for home health care may include the following when rendered pursuant to a KFHPWA-approved home health care plan of treatment: nursing care; restorative physical, occupational, respiratory and speech therapy; durable medical equipment; medical social worker and limited home health aide services. Home health services are covered on an intermittent basis in the Enrollee’s home. “Intermittent” means care that is to be rendered because of a medically predictable recurring need for skilled home health care. “Skilled home health care” means reasonable and necessary care for the treatment of an illness or injury which requires the skill of a nurse or therapist, based on the complexity of the service and the condition of the patient and which is performed directly by an appropriately licensed professional provider. Home health care requires Preauthorization. Exclusions: Private Duty Nursing; housekeeping or meal services; any care provided by or for a family member; any other services rendered in the home which do not meet the definition of skilled home health care above PEBB_CA_2024 25