Skilled Nursing Facility Skilled nursing care in a skilled nursing facility when full- After Deductible, Enrollee pays $250 Copayment per time skilled nursing care is necessary in the opinion of the day up to $1,250 per admission attending physician, limited to a total of 150 days per calendar year. Care may include room and board; general nursing care; drugs, biologicals, supplies and equipment ordinarily provided or arranged by a skilled nursing facility; and short- term restorative occupational therapy, physical therapy and speech therapy. Skilled nursing care in a skilled nursing facility requires Preauthorization. Exclusions: Personal comfort items such as telephone and television; rest cures; domiciliary or Convalescent Care Sterilization FDA-approved female sterilization procedures, services and Hospital - Inpatient: No charge; Enrollee pays supplies. See Preventive Services for additional information. nothing Non-Emergency inpatient hospital services require Hospital - Outpatient: No charge; Enrollee pays Preauthorization. nothing Outpatient Services: No charge; Enrollee pays nothing Vasectomy. Hospital - Inpatient: No charge: Enrollee pays nothing Non-Emergency inpatient hospital services require Preauthorization. Hospital - Outpatient: No charge; Enrollee pays nothing Outpatient Services: No charge; Enrollee pays nothing Exclusions: Procedures and services to reverse a sterilization Substance Use Disorder Substance use disorder services including inpatient Hospital - Inpatient: After Deductible, Enrollee Residential Treatment; diagnostic evaluation and education; pays $250 Copayment per day up to $1,250 per organized individual and group counseling; and/or admission prescription drugs unless excluded under Sections IV. or V. Outpatient Services: After Deductible, Enrollee Substance use disorder means a substance-related or addictive pays $30 primary care provider services Copayment disorder listed in the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). For the Group Visits: No charge; Enrollee pays nothing purposes of this section, the definition of Medically PEBB_VA_2024 41