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. If the patient purchases
a replacement hearing aid and is eligible for
benefits (subject to the applicable exclusions
shown 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 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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