Western PA/Susquehanna Member Guide

27 To find a participating hearing provider, log in to My Health OnLine and click Find Care. You can also call your Health Care Concierge team for assistance. Hearing benefits Some plans include routine hearing coverage. 6 The HMO Rx and PPO High Deductible with Rx plans do not offer hearing coverage. • One hearing exam • One hearing aid fitting • An allowance that can be used toward the cost of hearing aids Plan One hearing exam One hearing aid fitting Hearing aid allowance HMO Premier Rx (HMO) $0 copay per year $0 copay per year $500 per year HMO Deductible with Rx (HMO) $20 copay per year $20 copay per year $100 per year HMO Rx Choice (HMO) $0 copay per year $0 copay per year $500 per year HMO Rx Enhanced (HMO) $0 copay per year $0 copay every three years $1,500 every three years PPO Rx Enhanced (PPO) IN: $40 copay per year OUT: 30% coinsurance IN: $40 copay every three years OUT: 30% coinsurance IN/OUT: $1,500 every three years The HMO Rx Enhanced, PPO High Deductible with Rx, and PPO Rx Enhanced plans do not include an over-the-counter allowance. Over-the-counter (OTC) allowance Some plans now include a quarterly allowance to buy covered health and wellness products. 7 • At the start of each quarter, your OTC allowance will be added to your mail-order account. • You can order products through the mail-order catalog, online, by phone, or by mail. • Products will be shipped directly to your home in about 7-10 days. • At the end of each quarter, your allowance will expire. Make sure to use your allowance by the end of each quarter or you will lose any remaining balance on your account. Plan Over-the-counter allowance HMO Premier Rx (HMO) $25 per quarter HMO Deductible with Rx (HMO) $25 per quarter HMO Rx Choice (HMO) $40 per quarter HMO Rx (HMO) $50 per quarter