ELIGIBILITY
The Hearing Aid Program covers active and retired Longshoremen, Ship Clerks, Walking Bosses, Foremen and Watchmen members of Locals 26 and 75 and their qualified survivors and dependents who have eligibility under the ILWU-PMA Welfare Plan.
BENEFITS
A Hearing Aid Program benefit is payable after certification by a licensed medical or osteopathic doctor that an eligible person has a hearing loss that may be lessened by the use of a hearing aid. Effective April 1, 2003 the benefit is 90% of the expenses incurred in connection with the purchase of a hearing aid, up to a maximum of $760.00 ($1,520.00 if a hearing aid is required for both ears).
Included in the benefit are the costs of the hearing aid, the cost of batteries and other ancillary equipment provided at the time the hearing aid is purchased, the doctor's hearing examination charges if such charges are not otherwise covered, and the cost of service or repairs to the hearing aid. In general, a Hearing Aid Program Benefit is payable only once in a three year period. A hearing aid purchased for either ear will be covered provided at least three years have elapsed since a prior claim. Any unused portion of the benefit may not be carried forward to a future benefit period.
No benefit is provided under the Hearing Aid Program for a doctor’s hearing examination unless a hearing aid is purchased.
HOW TO CLAIM BENEFITS
An ILWU-PMA Welfare Plan Hearing Aid claim form should be submitted to the Benefit Plans office. Claim forms and instructions can be downloaded from the forms page. Claims forms are also available at ILWU Locals or from the Benefit Plans office. Claims received by the 10th of a month are paid by the end of the month,
Note: Oregon Kaiser eligibles must obtain a hearing aid through Kaiser. Please refer to your Oregon Kaiser booklet for more information. If you require a hearing aid for both ears, a claim form for the second aid must be submitted to the Benefit Plans office.
DOCTOR'S HEARING EXAMINATION CHARGES:
ILWU-PMA Coastwise Indemnity Plan Eligibles:
Claimants with hospital-medical-surgical coverage under the Coastwise indemnity Plan should first submit a separate medical claim to their health plan for reimbursement of the doctor's hearing examination charges. If the medical claim is denied or is not paid in full, a claim for the unpaid amount may be submitted as part of the Hearing Aid claim. Attach to the Hearing Aid claim form a copy of the doctor's bill together with evidence of the medical claim payment or denial.
Northern and Southern California Kaiser and Group Health Cooperative Eligibles:
Claimants enrolled under these HMO plans may obtain a doctor's examination at no charge through their health plan. If an HMO plan member chooses not to use his/her health plan for the hearing examination, a claim for an examination obtained elsewhere can be submitted with the Hearing Aid claim. Attach a copy of the doctor's bill to the Hearing Aid claim form. The cost of the examination will be included in the calculation of the Hearing Aid benefit that is paid.
