Summary Plan Description
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 maximum, this plan will not pay the additional costs. 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 patient 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.
Coverage Following Termination of Eligibility
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.
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