2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 3: Using the plan for your medical services 70 Example 1: You made 12 or fewer consecutive payments for the item in Original Medicare and then joined our plan. The payments you made in Original Medicare do not count. Example 2: You made 12 or fewer consecutive payments for the item in Original Medicare and then joined our plan. You were in our plan but did not obtain ownership while in our plan. You then go back to Original Medicare. You will have to make 13 consecutive new payments to own the item once you join Original Medicare again. All previous payments (whether to our plan or to Original Medicare) do not count. Section 7.2 Rules for oxygen equipment, supplies, and maintenance What oxygen benefits are you entitled to? If you qualify for Medicare oxygen equipment coverage our plan will cover: · Rental of oxygen equipment · Delivery of oxygen and oxygen contents · Tubing and related oxygen accessories for the delivery of oxygen and oxygen contents · Maintenance and repairs of oxygen equipment If you leave our plan or no longer medically require oxygen equipment, then the oxygen equipment must be returned. What happens if you leave your plan and return to Original Medicare? Original Medicare requires an oxygen supplier to provide you services for five years. During the first 36 months you rent the equipment. The remaining 24 months the supplier provides the equipment and maintenance (you are still responsible for the copayment for oxygen). After five years you may choose to stay with the same company or go to another company. At this point, the five-year cycle begins again, even if you remain with the same company, requiring you to pay copayments for the first 36 months. If you join or leave our plan, the five-year cycle starts over.