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.
Click the image for larger size.
Example 2
- Both hearing aids cost $4,000 through the network
provider.
- Member has met $500 of the deductible and out of pocket
maximum.
Click the image for larger size.
Example 3
- Both hearing aids cost $3,000 through the network provider.
- Member has met both the deductible and out of pocket maximum.
Click the image for larger size.
If you have any questions, contact Juliette Houseman, Benefits Specialist.
