Dec 27, 2023
Markets: All Virginia fully insured plans: Individual, Small Group, 51+ Group, Grandfathered Individual, Grandfathered Small Group, Grandfathered 51+ Group; Choice to opt in: Administrative Services Only (ASO) and CareFirst Administrators (CFA) ASO Groups
Effective January 1, 2024, upon plan issuance and renewal, the CareFirst Virginia plans listed above will provide hearing aids and related services coverage for:
- one (1) hearing aid per hearing-impaired ear every 24 months;
- up to $1,500 per hearing aid*; for
- children 18 years of age or younger
* The $1,500 limit does not apply to the related services.
Benefits are provided both in and out of network when applicable. In-network benefits are provided without any cost share (no deductible, copayment or coinsurance), except for HSA compatible plans which will apply a deductible. Out of network benefits may apply cost sharing depending upon the member’s contract.
Here are some additional details regarding the state-mandated coverage updates:
- Coverage for hearing aid services and equipment must be provided upon the recommendation of an otolaryngologist, licensed audiologist, or licensed hearing aid specialist.
- Hearing aids are defined as any wearable, non-disposable instrument or device designed or offered to aid or compensate for impaired human hearing—parts, attachments, accessories, or earmolds included. However, the coverage does not extend to associated batteries and cords. Hearing aids are not to be considered durable medical equipment.
- Covered hearing aid-related services include office visits and fittings, earmolds, and other necessary equipment, maintenance, and adaption training.
- A member must be allowed to choose a higher-priced hearing aid and may pay the difference in cost above $1,500, with no financial penalty to the member or to the provider of the hearing aid.
Contact your Amwins Connect Sales Representative with questions.
