2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 4: Medical Benefits Chart (what is covered and what you pay) 144 · Vitamins, minerals, nutritional supplements or other similar-type products. · Acupuncture under anesthesia, hospitalization or any related services. · Intravenous injections or solutions. · Prescription drugs or medicines, including non-legend or proprietary medication, that don't require a prescription order. Naturopathic Services You may visit any Naturopathic Provider for routine, medically related services. How to submit a claim or request reimbursement for naturopathic services If your provider doesn't submit a claim for you, you can ask us for a reimbursement. To receive a reimbursement, you must: · Get a copy of your itemized receipt(s) from the service provider · Make sure the receipt shows: - The provider’s name, address and phone number - Your name - The date the service was completed - The amount you paid (or “paid in full” if the total amount has been paid) · Send us the receipt(s) within 90 days of the date of service, or as soon as reasonably possible OptumHealth Care Solutions, LLC P.O. Box 212 Minneapolis, MN 55440-0212 We will process your reimbursement based on your benefits and send you an Explanation of Benefits (EOB). Limitations and exclusions This benefit does not cover herbs; homeopathic remedies, medications and nutritional supplements; vitamins or vitamin injections.