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. Essential Health Benefits set forth under the Patient Protection and Affordable Care Act of 2010, Benefits including the categories of ambulatory patient 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. Established Enrollee must have had at least one in-person appointment or at least one real-time Relationship interactive appointment using both audio and visual technology in the past year, with the provider providing audio only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system operated by KFHPWA. Or the Enrollee was referred to the provider providing audio-only telemedicine by a provider who they have had an in-person appointment within the past year. Evidence of Coverage The EOC is a statement of benefits, exclusions and other provisions as set forth in the (EOC) Group medical coverage agreement between KFHPWA and the Group. Family Unit A Subscriber and all their Dependents. Group An employer, union, welfare trust or bona-fide association which has entered into a Group medical coverage agreement with KFHPWA. Health Care Authority The Washington state agency that administers the PEBB and SEBB Programs. (HCA) Hospital Care Those Medically Necessary services generally provided by acute general hospitals for admitted patients. KFHPWA-designated A specialist specifically identified by KFHPWA. Specialist PEBB_CA_2024 71