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Acupuncture, Naturopathic, and Massage Therapy (PDF) All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest 500 NE Multnomah St., Suite 100, Portland, OR 97232 ©2020 Kaiser Foundation Health Plan of the Northwest 498115039_LBG_04-20 2021 Washington alternative care benefit (acupuncture, naturopathy, massage) This benefit covers self-referred acupuncture, naturopathic, and massage therapy services when obtained from participating providers. Benefits are subject to the cost shares, and visit and/or dollar limits shown below. Choose your benefit maximum, 3 options: Benefit maximum per year (naturopathy and massage combined) $1,000 / $1,500 / $2,000 Services You Pay* Acupuncture services (12-visit limit) Specialty office visit cost share Naturopathic medicine (benefit max applies) Specialty office visit cost share Massage therapy (12-visit limit and benefit max applies) $25 *If added to an HSA-qualified deductible plan, this benefit is subject to the deductible. Office visits You do not need a referral to make an appointment. There is no claim form to file. You pay your cost share directly to the provider when you receive care. Once your benefit limit has been reached, you pay 100% of the cost of services for the remainder of the calendar year. As a member, you will receive a discount of up to 20%. Participating providers We contract with the CHP Group, a network of alternative care providers, to provide covered services to members. Visit chpgroup.com for a list of participating providers or contact Member Services. Acupuncture services Acupuncturists influence the health of the body by the insertion of very fine needles. Acupuncture treatment is primarily used to relieve pain, reduce inflammation, and promote healing. Covered services include: ▪ Evaluation and management. ▪ Acupuncture. ▪ Electro acupuncture. This is not a contract. This benefit summary does not fully describe your benefit coverage with Kaiser Foundation Health Plan of the Northwest. Please see your Evidence of Coverage (EOC) for complete details of benefits as well as exclusions and limitations. In the event of a conflict between this summary and the EOC, the EOC will control. All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest 500 NE Multnomah St., Suite 100, Portland, OR 97232 ©2020 Kaiser Foundation Health Plan of the Northwest 498115039_LBG_04-20 Naturopathic medicine services Naturopathic medicine is a natural approach to health and healing that emphasizes a holistic approach to the diagnosis, treatment, and prevention of illness. Naturopathic physicians diagnose and treat patients by using natural modalities such as clinical nutrition, herbal medicine, and homeopathy. Covered services include evaluation and management. When prescribed during a naturopathic medicine visit, certain laboratory tests may be covered, as described in your Evidence of Coverage (EOC). Massage therapy services Therapeutic massage involves the manipulation of soft tissue structures of the body to help alleviate pain, muscle discomfort, and stress by helping to promote health and wellness. Covered services include evaluation and management. Alternative care exclusions ▪ Acupressure. motor vehicles; adaptive - Cytotoxic food allergy equipment; personal test. ▪ Behavioral training and lodgings; travel expenses; modification, including but not - Darkfield examination for and meals. limited to biofeedback, toxicity or parasites. hypnotherapy, play therapy, ▪ Expenses incurred for any - EAV and electronic tests and sleep therapy. services provided before for diagnosis or allergy. coverage begins or after ▪ Charges incurred as a result - Fecal transient and coverage ends. of missed appointment or an retention time. appointment not canceled. ▪ Expenses incurred as a result - Henshaw test. of treatment or service for ▪ Cosmetics, dietary - Intestinal permeability. pre-employment, school supplements, recreation, - Loomis 24-hour urine entrance, or athletic physical health or beauty classes, nutrient/enzyme analysis. examinations. aids, or equipment. - Melatonin biorhythm ▪ Experimental treatment ▪ Costs or charges incurred for challenge. including laboratory tests, which the member is not - Salivary caffeine X-rays, and services that are legally required to pay. clearance. provided primarily for medical ▪ Cupping. research purposes. - Sulfate/creatine ratio. - Thermography, hair ▪ Dental services, including ▪ Fertility services, including analysis, heavy metal temporomandibular joint reversal of sterilizations. (TMJ) services. screening, and mineral ▪ Gynecological services. studies. ▪ Dermal friction technique. ▪ Health or exercise classes, - Tryptophan load test. ▪ Disorders connected to aids, or equipment. - Urinary sodium benzoate. military service. ▪ Hearing exams. - Urine saliva pH. ▪ Durable medical equipment, ▪ Infertility services. - Zinc tolerance test. devices, appliances, ▪ Laserpuncture. orthotics, or prosthetics. ▪ The following laboratory services: ▪ Mental health services of any ▪ Environmental kind. enhancements; modifications - Comprehensive digestive to dwellings, property, or stool analysis. ▪ Moxibustion. This is not a contract. This benefit summary does not fully describe your benefit coverage with Kaiser Foundation Health Plan of the Northwest. Please see your Evidence of Coverage (EOC) for complete details of benefits as well as exclusions and limitations. In the event of a conflict between this summary and the EOC, the EOC will control. All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest 500 NE Multnomah St., Suite 100, Portland, OR 97232 ©2020 Kaiser Foundation Health Plan of the Northwest 498115039_LBG_04-20 ▪ MRIs, diagnostic ultrasounds, licensing, school, sports, safely be utilized in diagnosis CT scans, bone scans, and premarital, or those required or treatment. other special imaging studies. for court proceedings. ▪ Services considered ▪ Nambudripad allergy ▪ Point injection therapy experimental or eliminated technique (NAET). (aquapuncture). investigational. ▪ Nerve conduction studies, ▪ Preventive services. ▪ Services designed to electromyography, maintain optimal health in the ▪ Proctology services. computerized muscle testing, absence of symptoms. or range of motion testing. ▪ Public facility care required ▪ Smoking cessation. by federal, state, or local law. ▪ Obstetrical services. ▪ Sonopuncture. ▪ Radiological procedures ▪ Over-the-counter drugs, performed on equipment not ▪ Surgery. medications (prescription or certified, registered, or nonprescription) including ▪ Transportation services. licensed by the State of vitamins, minerals, nutritional Oregon or Washington, ▪ Vocational rehabilitation. or dietary supplements, or and/or radiological any other supply or product, ▪ X-ray documentation and/or procedures that, when whether or not prescribed. interpretation when reviewed by the CHP Group prescribed by an ▪ Physical examinations for are determined to be of such acupuncturist or naturopath. evaluations and reports for poor quality that they cannot This is not a contract. This benefit summary does not fully describe your benefit coverage with Kaiser Foundation Health Plan of the Northwest. Please see your Evidence of Coverage (EOC) for complete details of benefits as well as exclusions and limitations. In the event of a conflict between this summary and the EOC, the EOC will control. .
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