◦ Treatment of chronic tension-type headache with Botox or acupuncture ◦ Treatment of chronic migraine or chronic tension-type headache with massage, trigger point injections, transcranial magnetic stimulation, or manipulation/manual therapy (e.g., chiropractic services). Note: For chronic migraines and tension-type headaches, see page 53 42. Hearing aid items: ◦ Over-the-counter hearing aids that are not prescribed, except for initial assessment, fitting, adjustment, auditory training, and ear molds as necessary to maintain an optimal fit ◦ Charges incurred after your plan coverage ends, unless you ordered the hearing aid before that date and it is delivered within 45 days after your coverage ended ◦ Extended warranties, or warranties not related to the initial purchase of the hearing aid(s) ◦ Purchase of replacement batteries or other ancillary equipment, except those covered under terms of the initial hearing aid purchase The types of ancillary equipment not covered are: ◦ Alerting devices ◦ Assistive listening devices for FM/DM systems, receivers and transmitters ◦ Assistive listening devices for microphone transmitters ◦ Assistive listening devices for TDD machines ◦ Assistive listening devices for telephones ◦ Assistive listening devices for televisions (including amplifiers and caption decoders) ◦ Assistive listening devices for use with cochlear implants ◦ Assistive listening devices, supplies, and accessories not otherwise specified 43. Hip resurfacing 44. Hip surgery for treatment of Femoroacetabular Impingement (FAI) Syndrome 45. Home health care, except as described on page 54. The plan does not cover the following services: ◦ Housekeeping or meal services ◦ Care in any nursing home or convalescent facility ◦ Care provided by a family member 46. Hospital inpatient charges for non-essential services or features, such as: ◦ Admissions solely for diagnostic procedures that could be performed on an outpatient basis ◦ Personal or convenience items ◦ Reserved beds ◦ Services and devices that are not medically necessary (see definition on page 180) 47. Hyperbaric oxygen therapy treatment for: ◦ Acute and chronic sensorineural hearing loss ◦ Brain injury including traumatic (TBI) and chronic brain injury 2024 UMP CDHP (PEBB) Certificate of Coverage 109