Many insurance carriers that participate in the Federal Employees Health Benefits Program (FEHBP) have incorporated major upgrades into their 2008 hearing benefits for adults and children, following an ASHA–led advocacy campaign.
The benefits program provides health insurance for about 9 million federal employees and retirees and their families through hundreds of commercial carriers. Upgrades include hearing aids for children and bone-anchored hearing aids for adults, when medically necessary due to ear injury or malformation. Despite the improved benefits, plan costs increased by an average of only 2%.
ASHA advocated with the Office of Personnel Management (OPM), which administers FEHBP, for several years to improve hearing benefits. In 2005 ASHA helped OPM respond to a congressional inquiry on the feasibility of enhancing FEHBP hearing benefits by issuing the comprehensive "Briefing Document: Feasibility Study on Enhanced Hearing Benefits for the Federal Employee Health Benefit Program." The study compared FEHBP hearing benefits with those of other federal programs, including Medicaid and the Veterans Administration (now the Department of Veterans Affairs); ASHA found that hearing assessment and treatment benefits, which varied widely among FEHBP carriers, were often inadequate.
The report also included estimated costs of adding recommended hearing benefits, gleaned from a variety of sources. The Senate Committee on Homeland Security and Governmental Affairs reviewed the feasibility study. The document and ASHA's subsequent advocacy led to the improved OPM hearing benefit guidelines.
Outreach to Carriers
OPM's guidelines, however, did not automatically translate into better hearing health care benefits for subscribers to FEHBP plans. ASHA urged OPM to "require carriers to enhance their hearing assessment and treatment benefits" by requiring:
- A uniform, comprehensive core benefit for diagnostic and treatment services
- A maximum of $1,800 every three years for dependent children under 18 to purchase a hearing device
- A self-funded, supplemental hearing device benefit for employees, dependents over 18, and retirees
- Hearing devices to be prescribed, fit, and dispensed by a qualified audiologist
In response, OPM issued a March 2007 "Call Letter" to health insurance carriers bidding for FEHBP contracts. The letter outlined 2008 policy goals, which included ASHA's recommendations. OPM urged carriers to review their current hearing benefits "to ensure that newborns and children have coverage for appropriate screenings, testing, diagnostic evaluations, and treatment by licensed hearing professionals, including audiologists. We are encouraging proposals that include benefits for both professional services as well as hearing aids."
Carriers are encouraged, but not required, to adopt OPM policies; those that do, however, may heighten their competitive bidding and market advantage.
Hundreds of plans—fee-for-service, HMO, and PPO models—participate in FEHBP, making assessment of their response to the Call Letter difficult. However, a review of the 2008 nationwide fee-for-service plans provides a snapshot. Of those five plans, only the Mail Handlers Benefit Plans and the Blue Cross and Blue Shield Service Benefit Plan include new or improved coverage for hearing aids.
The Mail Handlers plan added coverage for one hearing aid per ear for all members once every calendar year. Previously, these services were covered only when directly related to an accidental injury.
The Blue Cross and Blue Shield Service Benefit Plans, also known as the Federal Employee Program (FEP), included all of the Call Letter hearing benefits. FEP, through 39 independent plans, covers about 4.5 million federal employees and retirees and their families. The plans upgraded hearing benefits for children and adults, with premium increases of less than 10%, to include hearing aids (including bone-anchored hearing aids) for children up to age 22 and bone-anchored hearing aids for adults when medically necessary due to traumatic injury or malformation of the external or middle ear (each benefit limited to $1,000 per ear per calendar year).
The others—APWU Health Plan, GEHA, and NALC—continue to exclude hearing aid coverage. NALC, however, added one newborn hearing screening test. ASHA will continue to monitor FEHBP carriers' responses to OPM guidelines.
ASHA members can help patients and clients advocate for better hearing health care coverage by encouraging them to enroll in FEHBP plans with good hearing benefits and to inform plans without the benefits that they are choosing a plan with better coverage.
Information on FEHBP carriers by state, including a plan comparison tool, links to plan brochures, changes from the previous year, patient safety programs, and links to plan provider directories is available at OPM Insurance Programs.