Welfare Summary Plan Description

5.15 HEARING LOSS BENEFIT

The Hearing Loss benefit provides for a hearing aid device. Covered Expenses include ear mold(s), initial set of batteries, cords and other necessary equipment, warranty, follow-up consultation, and repair of a hearing aid device. Hearing examinations and evaluations are covered under the Plan's medical benefits.

The maximum benefit payable is 70% of Covered Expenses, up to $800 per ear for hearing aid devices, during any period of three consecutive years. The calendar year deductible does not apply to this benefit, and any expense you incur over the Plan's paid benefit amount is not applied to the Annual Out-of-Pocket Limit.

No hearing loss benefit is extended for more than one hearing aid device for each ear; or for replacement of a hearing aid device more often than once during any period of three consecutive years.