2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 4: Medical Benefits Chart (what is covered and what you pay) 134 Services not covered by Not covered under any Covered only under specific Medicare condition conditions All services, procedures, Not covered under any treatments, medications and condition supplies related to workers’ compensation claims. Physical examinations for the Not covered under any purpose of maintaining or condition obtaining employment, licenses, insurance, court hearings, travel, dietary counseling, weight reduction programs or for premarital and pre-adoption purposes and/or other non-preventive reasons. Abortion. Cases resulting in pregnancies from rape or incest or that endanger the life of the mother. Your plan sponsor covers elective abortions. Health services for treatment of Not covered under any military service related condition disabilities provided by the Military Health Services System (including CHAMPUS or TRICARE) under which the federal government agrees to pay for the services and supplies. Paramedic intercept service Services are only covered when (advanced life support provided the ambulance pick-up address by an emergency service entity, is located in rural New York and such as a paramedic services applicable conditions are met. unit, which do not provide Members are responsible for all ambulance transport) paramedic intercept service costs that occur outside of rural New York. Optional, additional, or deluxe Not covered under any features or accessories to condition durable medical equipment,