2016-17 Medical Plan Changes to Vision and Hearing Benefits

Effective July 1, 2016, both of Heartland AEA’s medical plan options will provide additional coverage for vision exams, hearing exams and hearing aids, as follows:

• Vision exams – Routine vision exams will be covered once per year, at 100%.
• Hearing exams – Routine hearing exams will be covered once per year, at 100%.
• Hearing aids – Hearing aids will be covered, subject to deductible and coinsurance. The benefit is limited to once every three years and is capped at $2,500.
• Important: Members must see a medical plan network provider to receive these benefits.
  

Vision and Hearing Benefit Q & A:
Who do I make an appointment with?
For these plan benefits, you must make an appointment with an in-network provider, however, you may schedule directly with any network provider; you do not need a referral.

Where can I purchase a hearing aid?
You must purchase a hearing aid through a network Durable Medical Equipment provider to be covered under your medical plan.

Does our plan have specific audiologists?
Yes, for the hearing exam benefit, you must see a network provider. 

To find a network provider in your area:
Use the “Find a Doctor or Hospital tool” on Wellmark.com to make sure your provider is in the Blue Choice network. Search on “Find a Doctor” and select “Specialist” with a specialty type of Audiologist.

Hearing Aids must be purchased through a network Durable Medical Equipment provider. Search on “Find a Facility” and select “Specialty Facilities/Supplier” with a facility type of Durable Medical Equipment and Suppliers.

If you would rather call, use the Wellmark customer service number on your ID card.

What if it is less expensive to purchase my hearing aids from Costco or through a discount program?
It may be less expensive to purchase hearing aids from non-network providers, and you are not required to use the medical plan. However, hearing aids purchased from non-network providers will not be covered or reimbursed by the medical plan. You will want to consider your medical plan benefits, how much you have already met towards deductible and your out-of-pocket maximum, in determining the most cost-effective provider to purchase hearing aids.

If the $2,500 is being paid towards my hearing aids, is that towards both of them?
Yes, the medical plan will cover up to $2,500 total for both hearing aids. After the $2,500 cap, you will be responsible for the balance (as well as any deductible and/or coinsurance cost share).

Can I request reimbursement for my hearing aids through my HRA?
Yes, hearing aids are a reimbursable expense under both the HRA and our Flexible Spending Account plan.  These are reimbursable regardless if you purchase the hearing aids through the medical plan or not.

How much is this going to cost me?
Routine vision and hearing exams from network providers will be covered at 100% by the medical plan.

Your cost share for hearing aids will depend on your medical plan enrollment, and your medical plan benefit utilization. Following are some examples to help illustrate.

Example 1

• Both hearing aids cost $3,500 through the network provider.
• Member has not had any medical claims applied to deductible or out of pocket maximum during the current calendar year.

 

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Example 2

• Both hearing aids cost $4,000 through the network provider.
• Member has met $500 of the deductible and out of pocket maximum.

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Example 3

• Both hearing aids cost $3,000 through the network provider.
• Member has met both the deductible and out of pocket maximum.

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 If you have any questions, contact Juliette Houseman, Benefits Specialist.