CALIFORNIA - Pacificare Health Systems
CALIFORNIA - Pacificare Health Systems
CALIFORNIA - Pacificare Health Systems
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PART A<br />
Hearing Aid Benefits<br />
48<br />
50 percent coinsurance per device<br />
Maximum: $2,000 every 36 months<br />
Hearing aid expenses for Members are covered as<br />
follows:<br />
Benefits<br />
Hearing Aid Benefits include, but are not limited to:<br />
n<br />
n<br />
An audiometric examination by an audiologist<br />
when authorized through the Member’s<br />
Participating Medical Group. The associated office<br />
visit Copayment applies.<br />
Hearing aids or ear molds – One appliance per<br />
ear as listed above per Member, every 36 months<br />
when Medically Necessary to provide functional<br />
improvement and when authorized through<br />
the Member’s Participating Medical Group and<br />
obtained from a Participating PacifiCare Provider.<br />
No more than $2,000 will be paid every 36 months<br />
for all covered hearing aids combined. Retirees<br />
must acquire hearing aids through Newport<br />
Audiology.<br />
Limitations<br />
Coverage expenses relating to hearing aids are limited<br />
to the usual and customary charge of a basic hearing<br />
aid to provide functional improvement.<br />
Exclusions<br />
Certain hearing aid services are not covered, including,<br />
but not limited to the following:<br />
n<br />
n<br />
n<br />
n<br />
n<br />
Hearing Aid Benefits<br />
Replacement of a hearing aid that is lost, broken or<br />
stolen within 36 months of receipt.<br />
Repair of the hearing aid and related services.<br />
Surgically implanted hearing devices.<br />
Services or supplies for which a Member is entitled<br />
to receive reimbursement under any applicable<br />
workers’ compensation law.<br />
Services or supplies rendered to a Member after<br />
cessation of the coverage on his or her account,<br />
except that, if a hearing aid is ordered while<br />
coverage is in force on account of such Member<br />
and such a hearing aid is delivered within 60 days<br />
after the date of such cessation, such hearing aid<br />
will be considered a covered hearing aid expense.<br />
n<br />
n<br />
Services or supplies which are not necessary<br />
according to professionally accepted standards<br />
of practice, or which are not recommended or<br />
authorized by the Member’s Participating Medical<br />
Group.<br />
An eyeglass-type hearing aid or additional charges<br />
for a hearing aid designed specifically for cosmetic<br />
purposes.
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