Hearing Care

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.

  1. There is no deductible.
  2. Percentage Payable
    1. 80% of usual, customary and reasonable charges, known as UCR.  The percentage is applied to the covered hearing benefit charges.
  3. Hearing Benefit Maximum: $500 per ear
  4. Covered Hearing Charge: A “covered hearing charge” is a charge that meets all of the tests listed below:
    1. 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.
    2. 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.
  5. 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.
  6. 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:

    1. The actual hearing aid device;
    2. Ear mold(s);
    3. The initial batteries, cords, and other necessary ancillary equipment;
    4. A warranty; and
    5. A follow-up visit within 30 days after the delivery of the hearing aid device.
  7. Exclusions:
    No Hearing Benefit will be paid for the following:

    1. hearing aid device;
    2. A hearing aid device that exceeds the specifications of the prescription;
    3. 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.
    4. Service or supply that is otherwise covered by the medical plan the participant is enrolled in.
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