Hearing aids You pay $0 of the $3,000 benefit limit per ear every 3 calendar years once you have met your deductible for prescribed hearing aids. You are responsible for hearing aid charges exceeding the $3,000 benefit limit. See the definition of “Limited Benefit”. You pay the standard rate for the following hearing-related services: ▪ Ear mold(s) ▪ Initial battery, cords, and other ancillary equipment ▪ Warranty (only as included with the initial purchase) ▪ Follow-up consultation within 30 days after delivery of hearing aid ▪ Rental charges up to 30 days if you return the rented hearing aid before actual purchase ▪ Repair of hearing aid equipment ▪ The initial assessment, fitting, adjustment, auditory training, and other ear molds as necessary to maintain an optimal fit for those who have obtained or intend to obtain a hearing aid The following hearing-related items are not covered: • Over-the-counter hearing aids that are not prescribed, except for initial assessment, fitting, adjustment, auditory training, and ear molds as necessary to maintain an optimal fit • Charges incurred after your plan coverage ends, unless you ordered the hearing aid before that date and it is delivered within 45 days after your coverage ended • Extended warranties, or warranties not related to the initial purchase of the hearing aid(s) • Purchase of replacement batteries or other ancillary equipment, except those covered under terms of the initial hearing aid purchase The following ancillary equipment is not covered: • Alerting devices • Assistive listening devices for FM/DM systems, receivers and transmitters • Assistive listening devices for microphone transmitters • Assistive listening devices for TDD machines • Assistive listening devices for telephones • Assistive listening devices for televisions (including amplifiers and caption decoders) • Assistive listening devices for use with cochlear implants • Assistive listening devices, supplies, and accessories not otherwise specified • Hearing aid batteries Home health care ALERT! See the “What the plan does not cover” section for services the plan does not cover. In certain circumstances, the plan covers short-term, provider-directed, medically necessary home health services on an intermittent or part-time basis by a licensed home health, hospice, or home care agency, to 54 2024 UMP CDHP (PEBB) Certificate of Coverage