Summary Plan Description

Hearing Aids

90% Network and 80% Non-Network
The Hearing Aid Benefit Is Not Available Under Retiree Coverage

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 the patient purchases a replacement hearing aid and is eligible for benefits (subject to the applicable exclusions shown below), the prescription requirement 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:

  1. Replacing a hearing aid or a hearing aid part for any reason more than once in a three-year period.
  2. Hearing aids purchased or dispensed when the benefit is not in effect or when the patient is not covered under this plan.
  3. Batteries or other equipment other than that obtained upon purchase of the hearing aid.
  4. 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.
  5. 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.