2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Hearing Services
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Hearing Services
Note: We state whether or not the calendar year deductible applies for each benefit listed in this section.
Benefit Description
Hearing Services
Visits related to the covered hearing services listed below
You Pay
Preferred: $10 copayment (no deductible) per visit up to a combined total of 10 visits per calendar year (benefits combined with visits in Section 5(a) page 39)
Preferred provider, visits after the 10th visit: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Note: You pay 30% of the Plan allowance (deductible applies) for agents, drugs, and/or supplies administered or obtained in connection with your care. (See page 128 for more information about “agents.”)
Benefit Description
Hearing Services
Visits related to the covered hearing services listed below
You Pay
Preferred: $10 copayment (no deductible) per visit up to a combined total of 10 visits per calendar year (benefits combined with visits in Section 5(a) page 39)
Preferred provider, visits after the 10th visit: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Note: You pay 30% of the Plan allowance (deductible applies) for agents, drugs, and/or supplies administered or obtained in connection with your care. (See page 128 for more information about “agents.”)
Benefit Description
Hearing tests related to illness or injury
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Hearing tests related to illness or injury
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Benefit Description
Not covered:
You Pay
All charges
Not covered:
- Routine hearing tests (except as indicated on page 44)
- Hearing aids, including bone-anchored hearing aids, accessories or supplies(including remote controls and warranty packages) and all associated services
- Hearing aid exams
You Pay
All charges