Your Hearing Aid Reimbursement Benefit

What Is The Hearing Aid Reimbursement Benefit?
When Is Coverage Provided?&
What Expenses Are Covered By the Hearing Aid Reimbursement
What Is Not Covered?
Getting Your Benefit
No-Cost Option
At Your Own Expense


What Is The Hearing Aid Reimbursement Benefit
The Plan will provide you, your spouse and your eligible children up to a maximum of $600 toward covered hearing aid expenses once every two years.

When Is Coverage Provided?
Coverage is provided when:
  • Services are received in accordance with the procedures described in this Benefit Summary Plan Description.
  • Services are obtained while you, your spouse or your children are eligible for coverage (See the section entitled “Eligibility”).
  • Services are medically necessary and covered under this Benefit Summary Plan Description.
  • Services are not otherwise excluded.

What Expenses Are Covered By the Hearing Aid Reimbursement
Benefits are provided for:

  • Charges incurred for a hearing aid prescribed by a physician, otologist or audiologist.
  • Costs of hearing tests and evaluations performed by physicians, otologists or audiologists, but only if such tests result in the purchase of a hearing aid appliance prescribed by a physician, otologist or audiologist.

What Is Not Covered?
Benefits are not provided for:

  • Expenses not recommended or approval by a physician, otologist or audiologist.
  • Expenses for which benefits are payable under any Workers’ Compensation law.
  • Non-durable equipment, such as batteries.
  • Special procedures or training such as lip reading courses, schooling or institutional expenses.
  • Medical or surgical treatment of the ear or ears.
  • Charges for services or supplies which are covered in whole or in part under any other benefit plan of the Fund.
  • Repairs or adjustments of hearing aids.
  • Hearing tests and evaluations that do not result in the purchase of a hearing aid appliance prescribed by a physician, otologist or audiologist.
  • Services by a provider whose office is attached to certain hospitals within New York State (call the Fund Office for a list of such providers). *

* under the provisions of the Health Care Reform Act 1997.

Getting Your Benefit
Follow these simple steps:

  • Obtain a Hearing Aid Reimbursement Benefit Claim Form from the Fund Office.
  • Have the form completed at the time the services are rendere.d
  • Pay for the services or appliance.
  • Return the claim form to the Fund Office together with an itemized paid bill describing the services rendered, the date services were provided and the appliance purchased, the amount charged and the name of the person who required the hearing appliance. The claim form must be submitted to the Fund Office within 90 calendar days after the date the hearing appliance was purchased. Claims submitted after the 90-day limit will be denied.

No-Cost Option

The Fund has arranged with certain participating providers to make covered hearing aid expenses available to you, your spouse and eligible dependents.

If you choose the no-cost option, you, your spouse and your eligible dependents will receive at no out-of-pocket expense:

  • A comprehensive ear test
       and
  • An in the canal aid (ITC)
       or
  • An in the ear aid (ITE)
       or
  • A behind the ear aid (BTE)

At Your Own Expense:

  • Choose upgrades and second hearing aids at a 30% discount.

To Choose The No-Cost Option:

  • Contact the Fund Office for a list of participating providers and their locations.
  • Obtain a hearing aid claim form from the Fund Office.
  • To avoid out-of-pocket costs, ask the participating provider to show you the hearing aids covered by the program.
  • Plan Limitations apply (see “What Is the Hearing Aid Reimbursement Benefit?”).
PLEASE NOTE:

The Fund does NOT recommend or endorse specific providers. The no-cost option is made available to offer you potential cost savings. The decision to use this service is entirely up to you. As with any provider of services, you should apply the same criteria and care in choosing this provider that you would apply in choosing any other service you require.

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