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Vision Exam | Every 12 months | No charge | $40 allowance |
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Lenses | Every 24 months OR at a 12-month interval if the prescription change so indicates | No charge for standard lenses | Allowance varies based on lens type |
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Frames | Every 24 months | No charge for standard frame | $40 allowance |
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Contact Lenses | Every 24 months OR at 12-month intervals and if the prescription change so indicates (this benefit is in lieu of lenses and frame) | Cosmetic or convenience: $150 allowance
Medically necessary: Covered in full | Cosmetic or convenience: $150 allowance
Medically necessary: $250 allowance |
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1. Out of area Hearing Aids, Audiology: if you live more than 30 miles away from Sacramento Ear, Nose and Throat, pre-authorization is required for the initial audiology visit. If authorized, the visit is covered at 80% of usual, reasonable and customary, after the deductible. If hearing aids are needed, your audiology report must be sent to Sacramento Ear, Nose and Throat so the hearing aids can be authorized. Hearing aids are covered at 80% of usual, customary & reasonable, after deductible, up to $1,000 per ear. Only in-network benefits count toward the $10,000 coinsurance maximum. Whether or not you live within the network service area, charges incurred out-of-network will never be paid at 100%.
2. Annual hearing aid maintenance check is required. If you fail to obtain this annual maintenance check, the Fund will not pay for replacement of hearing aids.
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Medicare Hearing Aids, Audiology |
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Audiology Visits | 90% of contract 2 after deductible, if provided through Sacramento Ear, Nose and Throat and pre-authorized. | Not covered 1
(Out of Area 80% of usual, customary & reasonable 3, after deductible, if pre-authorized) |
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Hearing Aids | 100% of contract 2 after deductible, if provided through Sacramento Ear, Nose and Throat and pre-authorized. | Not covered 1
(Out of Area 80% of usual, customary & reasonable 3, after deductible, if pre-authorized and approved by Sacramento Ear, Nose and Throat) |
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| Pre-Authorization is Required
$2,000 ($1,000 per ear) maximum payment. Annual hearing aid maintenance check is required. 4
Children (under age of 18): one aid per year every calendar year
Adults (18 & over): one aid per ear every 3 years. |
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Maintenance Check
| 75% of contract amount 2, after deductible. | Not covered1
(Out-of-area primary care physician paid at 80% of usual, customary & reasonable). |
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| $30 maximum per year |
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Non-Medicare
Hearing Aids, Audiology |
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Audiology Visits | 90% of after deductible, if provided through Sacramento Ear, Nose and Throat and pre-authorized. | Not covered 1
(Out of Area 80% of usual, customary & reasonable, after deductible, if pre-authorized) |
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Hearing Aids | 100% of contract amount when provided through Sacramento Ear, Nose and Throat and pre-authorized. | Not covered 1
(Out of Area 80% of usual, customary & reasonable, after deductible, if pre-authorized and approved by Sacramento Ear, Nose and Throat) |
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| Pre-Authorization is Required
$2,000 ($1,000 per ear) maximum payment. Annual hearing aid maintenance check is required. 2
Children (under age of 18): one aid per year every calendar year
Adults (18 & over): one aid per ear every 3 years. |
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Maintenance Check
| | 75% of contract amount customary & reasonable, after deductible. |
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| $30 maximum per year |
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