The Trust will pay a Hearing Benefit, regardless of which medical plan a Participant is enrolled in, for the covered hearing benefit charges a Covered Person incurs while otherwise eligible under the Plan. A Covered Person is an Active employee only. Dependents are not eligible for this benefit.
- There is no deductible.
- Percentage Payable
- 80% of usual, customary and reasonable charges, known as UCR. The percentage is applied to the covered hearing benefit charges.
- Hearing Benefit Maximum: $500 per ear
- Covered Hearing Charge: A “covered hearing charge” is a charge that meets all of the tests listed below:
- It is made by a physician or a certified or licensed audiologist for a service or supply that is listed in the Covered Charges List and is furnished to a covered person.
- It is incurred by a person while covered for the Hearing Benefit. A charge is incurred at the time the service is rendered or the supply is furnished for which the charge is made.
- Covered Charge Limits:
The “covered charge limits” that apply to each service or supply are (a) the usual charge for the service or supply; and (b) the customary charge for the service or supply. - Covered Charges List:
The charge for an otologic examination made by a physician, but not for more than one examination during any five-year period.
The charge for an audio logic examination made by a certified or licensed audiologist, and the charge for one follow-up visit.
The charges incurred in connection with the purchase of a hearing aid device (monaural or binaural) prescribed as a result of examinations, but only if the examining physician or audiologist certifies that he covered person has hearing loss that may be lessened by the use of a hearing aid device. The charges include the charges for:- The actual hearing aid device;
- Ear mold(s);
- The initial batteries, cords, and other necessary ancillary equipment;
- A warranty; and
- A follow-up visit within 30 days after the delivery of the hearing aid device.
- Exclusions:
No Hearing Benefit will be paid for the following:- hearing aid device;
- A hearing aid device that exceeds the specifications of the prescription;
- Batteries or other ancillary equipment, except those purchased with the Service or supply that is not necessary or that does not meet professionally recognized standards.
- Service or supply that is otherwise covered by the medical plan the participant is enrolled in.