Prescription drugs are covered the same as for any other pays $30 primary care provider services Copayment condition (see Drugs – Outpatient Prescription for coverage) or $50 specialty care provider services Copayment Counseling services are covered the same as for any other condition (see Mental Health and Wellness for coverage). Non-Emergency inpatient hospital services require Preauthorization. Exclusions: Cosmetic services and surgery not related to gender affirming treatment (i.e., face lift or calf implants); complications of non-Covered Services Hearing Examinations and Hearing Aids Hearing exams for hearing loss and evaluation are covered Hospital - Inpatient: After Deductible, Enrollee only when provided at KFHPWA-approved facilities. pays $250 Copayment per day up to $1,250 per admission Cochlear implants and surgically implanted Bone Anchored Hearing System (BAHS) when in accordance with KFHPWA Hospital - Outpatient: After Deductible, Enrollee clinical criteria. pays $200 Copayment Covered services for initial cochlear implants and surgically Outpatient Services: After Deductible, Enrollee implanted BAHS include diagnostic testing, pre-implant pays $30 primary care provider services Copayment testing, implant surgery, post-implant follow-up, speech or $50 specialty care provider services Copayment therapy, programming and associated supplies (such as transmitter cable, and batteries). Replacement devices and associated supplies – see Devices, Equipment and Supplies Section. Hearing aids, externally worn bone conduction hearing Enrollee pays nothing, limited to an Allowance of 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 $30 primary care provider services Copayment or $50 specialty care provider services Copayment Exclusions: Programs or treatments for hearing loss or hearing care including associated with 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 PEBB_VA_2024 25