Hearing
Aids – 90%
Benefits are provided for
hearing aids prescribed by a physician or audiologist with a maximum of $1,000
per ear in any three consecutive year period. If expenses exceed this $1,000 per
ear in any three consecutive year period, this plan will not pay the additional
costs. If the individual purchases a replacement hearing aid and is eligible for
benefits (subject to the applicable exclusions listed below), the requirement
for certification is waived.
Covered services and supplies
include:
- An
otologic examination by a physician.
- An
audiological
examination and hearing evaluation by a certified or licensed audiologist
including a follow-up consultation.
- The
hearing aid (monaural or binaural) prescribed as a result of such examination,
which includes ear mold(s), the hearing aid instrument, the initial batteries,
cords and other necessary related equipment, a warranty, and follow-up
consultation within thirty days following delivery of the hearing
aid.
Benefits
are not
provided for:
- Replacing
a hearing aid or a hearing aid part for any reason more than once in a
three-year period.
- Hearing
aids purchased or dispensed when the benefit is not in effect or when the
individual is not covered under this plan.
- Batteries
or other equipment other than that obtained upon purchase of the hearing
aid.
- Charges
for hearing aids that do not meet professionally accepted standards of practice,
including charges for any such services or supplies that are experimental in
nature.
- A
hearing aid which exceeds the specifications prescribed for correction of
hearing loss.
- Eyeglass-type
hearing aids if the charge exceeds the allowable expense for one hearing
aid.
Coverage Following
Termination of Eligibility – Hearing Aids
When a hearing aid is
prescribed and ordered prior to termination of coverage, benefits are available
if the prescribed device is delivered and purchased within 60 days after
termination of coverage. Benefits are based on the benefits in effect on the
date coverage terminated.
|
|
|
