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HEARING AID BENEFIT
The Plan pays for audiology on the same basis as any other specialist physician visits. For audiology, Sacramento ENT
(Ear, Nose and Throat) is the sole preferred provider.
For hearing aids prescribed by a Sacramento ENT Medical Group provider, the Plan pays 90% of the contract amount,
after deductible, up to a maximum total payment of $4,000 ($2,000 per ear). For hearing aids prescribed by a provider
other than Sacramento ENT, the Plan pays 70% of usual, customary and reasonable, after the deductible, up to a maximum
total payment of $4,000 ($2,000 per ear), if the hearing aids are Pre-Certified by Sacramento ENT. No hearing aid
benefit will be paid unless the aids are provided by or Pre-Certified by Sacramento ENT.
For adults, the Plan will cover a maximum of one hearing device per ear every three years, if necessary as determined by
the Plan. For children, the frequency is one device per ear annually, if necessary as determined by the Plan.
An annual hearing aid maintenance check is required. Maintenance checks are covered at 70% of the contract
amount or usual, customary and reasonable, up to $30 per year. If you fail to obtain this annual maintenance check, the
Plan may not pay for replacement of hearing aids.
The Plan does not cover replacement of hearing aid batteries and parts.
Sacramento ENT Medical Group is located at:
1111 Exposition Blvd., Building 700
Sacramento, California 95815
(916) 736-1911
fax: (916) 736-0445
