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Alberta Health. AADL Approved Products List Hearing Aids, Bone Anchored Hearing Devices and Cochlear Implants Pricing effective April 1, 2016

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AADL Approved Products List – Hearing Aids,

Bone Anchored Hearing Devices and Cochlear Implants

Pricing effective

April

1, 2016

Cost Share Seniors and Adult Dependents of Seniors ... APL H-1

Cost Share Exempt Seniors and Adult Dependents of Seniors ... APL H-3

Cost Share Exempt Adults ... APL H-5

Eligible Full Time Students 18 to 24 Years ... APL H-7

Children Under 18 Years ... APL H-9

Bone Anchored Hearing Devices ... APL H-11

Cochlear Implants ... APL H-12

(2)

SCHEDULE A

PAYMENT TERMS

COST SHARE Seniors and Adult Dependents of Seniors

(subject to cost-sharing AADL 75% - Client 25%)

AADL

CAT # DESCRIPTION OF PRODUCT/SERVICE

FREQUENCY

LIMIT PRICE - CANADIAN DOLLARS

H048 Return Fee 1/5 years $150 Cannot be billed if device not trialed 1

H009 H010 H021 H011 H012 H013 H019 H022 H023

High power BTE hearing aid (HFA FOG ≥ 60 dB)

Behind-the-ear hearing aid Receiver In the Canal hearing aid In-the-ear hearing aid

Body type hearing aid Eyeglass type hearing aid Bone conduction hearing aid CROS hearing aid 3

Bi-CROS hearing aid 3

1/5 years $1,200 If Specialty Supplier's advertised

price is less than AADL maximum, advertised price is then cost-shared.2

H024 CROS/Bi-CROS microphone 1/5 years Manufacturer’s invoice cost up to a

maximum of $700. 3

H375 Assistive listening device (may only be substituted for a conventional hearing

aid with AADL Program Manager prior approval) 1/5 years Manufacturer’s invoice cost + $100 for fitting and follow-up services.

H030 H035

Earmold (new or replacement) (not paid with H011)

Service fee for replacement earmold (not within 12 mo. of HA fitting)

1/year 1/year

Manufacturer's invoice cost up to a maximum of $70

$40 4

H051

H072

In-house receiver repair for a Receiver in the Canal (RIC) hearing aid.

Applicable only to aid(s) registered with the AADL program and only after the

original purchase warranty on the receiver has expired.

Service fee for in-house RIC repair only after the original purchase warranty on the receiver has expired.

1/yr

1/yr

Manufacturer's invoice to a maximum of $60

$30 5

H040

H045

Major repair to hearing aids (parts and labour) by manufacturer or qualified repair laboratory. Applicable only to aid(s) registered with the AADL Program

and only after the original purchase warranty has expired.

Service fee for major repair only after one year past the instrument billing date.

1/year

1/year

Manufacturer's invoice to a maximum of $300 6

(3)

H055 H056 H057

Replacement bone conduction receivers for bone conduction hearing aids. Applicable only after one year past instrument billing date.

Cords for CROS/Bi-CROS, body type hearing aids (audio input cords excluded) Air conduction receivers for body type hearing aids

1/year 1/year 1/year

Manufacturer's invoice cost up to $100 Manufacturer's invoice cost up to $30 Manufacturer's invoice cost up to $25 1. The Return Fee is a flat rate fee which includes the cost of the assessment, earmold and service fee. No extra billing on fees is

permitted.

2. Flat rate fee includes assessment, cost of instrument and service fee. Clients may choose a higher priced instrument (upgrade) but an appropriate basic entry level technology hearing aid must be offered at the AADL maximum price.

3. H022 (CROS hearing aid) or H023 (Bi-CROS hearing aid) will always be billed in conjunction with a H024 (CROS/Bi-CROS microphone). 4. The service fee of $40 is available to all AADL Clients who are having their earmold replaced after 1 year of use. No extra billing on fees

is permitted.

5. The service fee on repairs is available to all AADL Clients. No extra billing on fees is permitted. Service certificates and manufacturers' invoices must be kept on file. The service fee may be claimed in the final year of a manufacturer's two year warranty. Should the aid require repair in the following year, both the service and repair fees may be claimed regardless of when the repair occurs. Following this, the fees cannot be claimed for twelve months from the date of service. After the fourth year, a six-month warranty is acceptable. This applies to AADL Clients of all ages.

6. CROS/BICROS repairs can bill one major repair fee for the hearing aid/receiver and transmitter to a maximum of $300. CROS/BICROS hearing aid repairs can only bill one service fee to a maximum of $70. Enter one major repair fee and one service fee in E-business with serial numbers in benefit notes.

 To calculate the exchange rate on U.S. dollars, use the rate on the first day of the month that the invoice is dated and round it to the nearest .01

Please note Seniors and Adult Dependents of Seniors who have maxed out their annual cost-share contribution

(4)

PAYMENT TERMS

COST SHARE EXEMPT Seniors and Adult Dependents of Seniors

AADL

CAT # DESCRIPTION OF PRODUCT/SERVICE

FREQUENCY

LIMIT PRICE - CANADIAN DOLLARS

H448 Return Fee 1 per affected

ear/5 years $150 Cannot be billed if device is not trialed

1

H409 H410 H411 H421

High power BTE hearing aid (HFA FOG ≥ 60 dB)

Behind-the-ear hearing aid In-the-ear hearing aid

Receiver In the Canal hearing aid 1 per affected ear/5 years $1200 - maximum per aid, or if Specialty

Supplier's advertised price is less than $1200, advertised price is then billed to AADL.2 H412 H413 H419 H422 H423

Body type hearing aid Eyeglass type hearing aid Bone conduction hearing aid CROS hearing aid 3

Bi-CROS hearing aid 3

1/5 years

H424 CROS/Bi-CROS microphone 1/5 years Manufacturer’s invoice cost up to a maximum of $700 3

H475 Assistive listening device (may only be substituted for a conventional hearing

aid with AADL Program Manager prior approval) 1/5 years Manufacturer’s invoice cost + $100 for fitting and follow-up services.

H430 H435

Earmold (new or replacement) (not paid with H411)

Service fee for replacement earmold (not within 12 mo. of HA fitting)

1/year per ear 1/year per ear

Manufacturer's invoice cost up to a maximum of $70

$40 4

H451

H472

In-house receiver repair for a Receiver in the Canal (RIC) hearing aid.

Applicable only to aid(s) registered with the AADL program and only after the

original purchase warranty on the receiver has expired.

Service fee for in-house RIC repair only after the original purchase warranty on the receiver has expired.

1/year per ear

1/year per ear

Manufacturer's invoice to a maximum of $60 $30 5

H440 Major repair to hearing aids (parts and labour) by manufacturer or qualified repair laboratory. Applicable only to aid(s) registered with the AADL Program

and only after the original purchase warranty has expired.

1/year per ear Manufacturer's invoice to a maximum of $300 6

(5)

H445 Service fee for major repair only after one year past the instrument billing date. 1/year per ear $70 5,6

H455 H456 H457

Replacement bone conduction receivers for bone conduction hearing aids. Applicable only after one year past instrument billing date.

Cords for CROS/Bi-CROS, body type hearing aids (audio input cords excluded) Air conduction receivers for body type hearing aids

1/year 1/year 1/year

Manufacturer's invoice cost up to $100 Manufacturer's invoice cost up to $30 Manufacturer's invoice cost up to $25 1. The Return Fee is a flat rate fee which includes the cost of the assessment, earmold and service fee. No extra billing on fees is

permitted.

2. Flat rate fee includes assessment, cost of instrument and service fee. Clients may choose a higher priced instrument (upgrade) but an appropriate basic entry level technology hearing aid must be offered at the AADL maximum price.

3. H022 (CROS hearing aid) or H023 (Bi-CROS hearing aid) will always be billed in conjunction with a H024 (CROS/Bi-CROS microphone). 4. The service fee of $40 is available to all AADL Clients who are having their earmold replaced after 1 year of use. No extra billing on fees

is permitted.

5. The service fee on repairs is available to all AADL Clients. No extra billing on fees is permitted. Service certificates and manufacturers' invoices must be kept on file. The service fee may be claimed in the final year of a manufacturer's two year warranty. Should the aid require repair in the following year, both the service and repair fees may be claimed regardless of when the repair occurs. Following this, the fees cannot be claimed for twelve months from the date of service. After the fourth year, a six-month warranty is acceptable. This applies to AADL Clients of all ages.

6. CROS/BICROS repairs can bill one major repair fee for the hearing aid/receiver and transmitter to a maximum of $300. CROS/BICROS hearing aid repairs can only bill one service fee to a maximum of $70. Enter one major repair fee and one service fee in E-business with serial numbers in benefit notes.

 To calculate the exchange rate on U.S. dollars, use the rate on the first day of the month that the invoice is dated and round it to the nearest .01

(6)

PAYMENT TERMS

COST SHARE EXEMPT Adults *(18 to 64) covered by the AADL Program

AADL

CAT # DESCRIPTION OF PRODUCT/SERVICE

FREQUENCY

LIMIT PRICE – CANADIAN DOLLARS

H748 Return Fee 1per affected

ear/5 years $150 –returned Cannot be billed unless device trialed and 1

H709 H710 H711 H721

High power BTE hearing aid (HFA FOG ≥ 60 dB)

Behind-the-ear hearing aid In-the-ear hearing aid

Receiver In the Canal hearing aid

1per affected ear/5 years

$1,200 maximum per aid, or if Specialty Supplier's advertised price is less than $1,200 advertised price is then billed to AADL.2 H712 H713 H719 H722 H723

Body type hearing aid Eyeglass type hearing aid Bone conduction hearing aid CROS hearing aid 3

Bi-CROS hearing aid 3

1/5 years

H724 CROS/Bi-CROS microphone 1/5 years Manufacturer’s invoice cost up to maximum of $700 3

H775 Assistive listening device (may only be substituted for a conventional hearing

aid with AADL Program Manager prior approval) 1/5 years Manufacturer’s invoice cost + $100 for fitting and follow-up services.

H730 H735

Earmold (new or replacement) (not paid with H711)

Service fee for replacement earmold (not within 12 mo. of HA fitting)

1/year per ear 1/year per ear

Manufacturer's invoice cost up to a maximum of $70

$40 4

H751

H772

In-house receiver repair for a Receiver in the Canal (RIC) hearing aid.

Applicable only to aid(s) registered with the AADL program and only after the

original purchase warranty on the receiver has expired.

Service fee for in-house RIC repair only after the original purchase warranty on the receiver has expired.

1/year per ear

1/year per ear

Manufacturer's invoice to a maximum of $60

$30 5

H740 Major repair to hearing aids (parts and labour) by manufacturer or qualified repair laboratory. Applicable only to aid(s) registered with the AADL Program

1/year per ear Manufacturer's invoice to a maximum of

(7)

H745

and only after the original purchase warranty has expired.

Service fee for major repair only after one year past the instrument billing date. 1/year per ear $70 5,6

H755 H756 H757

Replacement bone conduction receivers for bone conduction hearing aids. Applicable only after one year past instrument billing date.

Cords for CROS/Bi-CROS, body type hearing aids (audio input cords excluded) Air conduction receivers for body type hearing aids

1/year 1/year 1/year

Manufacturer's invoice cost up to $100 Manufacturer's invoice cost up to $30 Manufacturer's invoice cost up to $25 1. The Return Fee is a flat rate fee which includes the cost of the assessment, earmold and service fee. No extra billing on fees is

permitted.

2. Flat rate fee includes assessment, cost of instrument and service fee. Clients may choose a higher priced instrument (upgrade) but an appropriate basic entry level technology hearing aid must be offered at the AADL maximum price.

3. H022 (CROS hearing aid) or H023 (Bi-CROS hearing aid) will always be billed in conjunction with a H024 (CROS/Bi-CROS microphone). 4. The service fee of $40 is available to all AADL Clients who are having their earmold replaced after 1 year of use. No extra billing on fees

is permitted.

5. The service fee on repairs is available to all AADL Clients. No extra billing on fees is permitted. Service certificates and manufacturers' invoices must be kept on file. The service fee may be claimed in the final year of a manufacturer's two year warranty. Should the aid require repair in the following year, both the service and repair fees may be claimed regardless of when the repair occurs. Following this, the fees cannot be claimed for twelve months from the date of service. After the fourth year, a six-month warranty is acceptable. This applies to AADL Clients of all ages.

6. CROS/BICROS repairs can bill one major repair fee for the hearing aid/receiver and transmitter to a maximum of $300. CROS/BICROS hearing aid repairs can only bill one service fee to a maximum of $70. Enter one major repair fee and one service fee in E-business with serial numbers in benefit notes.

 To calculate the exchange rate on U.S. dollars, use the rate on the first day of the month that the invoice is dated and round it to the nearest .01

*Cost-share exempt adults (18-64) include clients on AISH and EI programs, and clients who qualify for cost-share

exemption based on AADL’s cost-share policy income thresholds.

*Cost-share adults (18-64) who have maxed out their annual cost-share contribution of $500, through the receipt of

other AADL benefits are not eligible for hearing aid benefits.

(8)

PAYMENT TERMS

Eligible Full Time Students 18 to 24 Years (subject to cost-sharing AADL 75% - Client 25%)

AADL

CAT # DESCRIPTION OF PRODUCT/SERVICE

FREQUENCY

LIMIT PRICE - CANADIAN DOLLARS

H714

H748 Hearing Assessment (only billed with hearing aid) Return Fee (cannot be billed unless device trialed and returned) 1/5 years 1 per affected ear/5 years $75 (AHS sites cannot bill) $150 1

H709 H710 H711 H721

High power BTE hearing aid (HFA FOG ≥ 60 dB) Behind-the-ear hearing aid

In-the-ear hearing aid

Receiver In the Canal hearing aid 1 per affected ear/5 years

Manufacturer's unit invoice cost up to $650 H712

H713 H719 H722 H723

Body type hearing aid Eyeglass type hearing aid Bone conduction hearing aid CROS hearing aid 2

Bi-CROS hearing aid 2

1/5 years

H724 CROS/Bi-CROS microphone 1/5 years Manufacturer’s invoice cost up to a maximum of $700 2

H715 General Service Fee 1/5 years $600

H720 Service Fee for Second Aid of a Binaural Fitting (not paid with H722, H723) 1/5 years $600

H730 H735

Earmold (new or replacement) (not paid with H711)

Service fee for replacement earmold (not within 12 mo. of HA fitting)

1/year per ear 1/year per ear

Manufacturer's invoice cost up to a maximum of $70

$40 3

H751

H772

In-house receiver repair for a Receiver in the Canal (RIC) hearing aid. Applicable only to aid(s) registered with the AADL program and only after

the original purchase warranty on the receiver has expired.

Service fee for in-house RIC repair only after the original purchase warranty on the receiver has expired.

1/year per ear

1/year per ear

Manufacturer's invoice to a maximum of $60

$30 4

H740 Major repair to hearing aids (parts and labour) by manufacturer or qualified repair laboratory. Applicable only to aid(s) registered with the AADL

Program and only after original purchase warranty has expired.

(9)

AADL

CAT # DESCRIPTION OF PRODUCT/SERVICE

FREQUENCY

LIMIT PRICE - CANADIAN DOLLARS

H745 Service fee for major repair only after 1 year past the instrument billing date. 1/year/per aid $70 4,5

H755 H756 H757

Replacement bone conduction receivers for bone conduction hearing aids. Applicable only after one year from instrument billing date.

Cords for CROS/Bi-CROS, body type hearing aid (audio input cords excluded) Air conduction receivers for body type hearing aids

1/year 1/year 1/year

Manufacturer's invoice cost up to $100 Manufacturer's invoice cost up to $30 Manufacturer's invoice cost up to $25 H700

H725 H705 H750 H760

Frequency Modulation (FM) or Digital Modulation (DM) System FM/DM Fitting Fee

Major Repair to FM/DM (Same conditions as H740)

Service Fee for major FM/DM repairs (Same conditions as H745) FM/DM Return Fee (cannot be billed unless device trialed and returned)

1/5 years 1/5 years

1/yr per component to maximum of 3/year 1/yr per component to maximum of 3/year 1/5 years

Manufacturer's invoice cost up to $1,900 $450

Manufacturer's invoice to a max. of $300 $70

$75

1. The Return Fee is a flat rate fee which includes the cost of the assessment, earmold and service fee. No extra billing on fees is permitted.

2. H722 (CROS hearing aid) or H723 (Bi-CROS hearing aid) will always be billed in conjunction with H724 (CROS/Bi-CROS microphone). 3. The service fee of $40 is available to all AADL Clients who are having their earmold replaced after 1 year of use. No extra billing on fees

is permitted.

4. The service fee on repairs is available to all AADL Clients. No extra billing on fees is permitted. Service certificates and manufacturers' invoices must be kept on file. The service fee may be claimed in the final year of a manufacturer's two year warranty. Should the aid require repair in the following year, both the service and repair fees may be claimed regardless of when the repair occurs. Following this, the fees cannot be claimed for twelve months from the date of service. After the fourth year, a six-month warranty is acceptable. This applies to AADL Clients of all ages.

5. CROS/BICROS repairs can bill one major repair fee for the hearing aid/receiver and transmitter to a maximum of $300. CROS/BICROS hearing aid repairs can only bill one service fee to a maximum of $70. Enter one major repair fee and one service fee in E-business with serial numbers in benefit notes.

 To calculate the exchange rate on U.S. dollars, use the rate on the first day of the month that the invoice is dated and round it to the nearest .01

(10)

PAYMENT TERMS

Children under 18 Years (subject to cost-sharing AADL 75% - Client 25%)

AADL

CAT # DESCRIPTION OF PRODUCT/SERVICE

FREQUENCY

LIMIT PRICE - CANADIAN DOLLARS

H108

H148 Hearing Assessment (cannot be billed unless device trialed and/or returned) Return Fee (cannot be billed unless device trialed and returned) 1/5 years 1 per affected ear/5 years $75 (AHS sites cannot bill) $150 1

H109 H110 H111 H121

High power BTE hearing aid (HFA FOG ≥ 60 dB) Behind-the-ear hearing aid

In-the-ear hearing aid

Receiver In the Canal hearing aid 2/5 years - binaural

Manufacturer's unit invoice cost up to $650 H112

H113 H119 H122 H123

Body type hearing aid Eyeglass type hearing aid Bone conduction hearing aid CROS hearing aid 2

Bi-CROS hearing aid 2

1/5 years - monaural

H124 CROS/Bi-CROS microphone 1/5 years Manufacturer’s invoice cost up to a maximum of $700 2

H115 General Service Fee 1/5 years $600

H120 Service Fee for Second Aid of a Binaural Fitting (not paid with H122, H123) 1/5 years $600

H126

H128

Earmold (new or replacement) (not paid with H111)

Service fee for replacement earmold (not with a new HA fitting)

1 every 3 months per ear (0-3 yrs of age)

1 every 6 months per ear (4-17 yrs of age)

1 every 3 months per ear (0-3 yrs of age)

1 every 6 months per ear (4-17 yrs of age)

Manufacturer's invoice cost up to $70

$40 3

H151 In-house receiver repair for a Receiver in the Canal (RIC) hearing aid. Applicable only to aid(s) registered with the AADL program and only after

the original purchase warranty on the receiver has expired.

1/year per ear Manufacturer's invoice to a maximum of

(11)

AADL

CAT # DESCRIPTION OF PRODUCT/SERVICE

FREQUENCY

LIMIT PRICE - CANADIAN DOLLARS

H172 Service fee for in-house RIC repair only after the original purchase warranty

on the receiver has expired. 1/year per ear $30

4

H140 H145

Major repair to hearing aids (parts and labour) by manufacturer or qualified repair laboratory. Applicable only to aid(s) registered with the AADL

Program and only after original purchase warranty has expired.

Service fee for major repair only after 1 year past the instrument billing date.

1/year/ aid 1/year/ aid

Manufacturer's invoice to a max. of $300 5 $70 4,5

H155 H156 H157

Replacement bone conduction receivers for bone conduction hearing aids. Applicable only after one year from instrument billing date.

Cords for CROS/Bi-CROS, body type hearing aid (audio input cords excluded) Air conduction receivers for body type hearing aids

1/year 1/year 1/year

Manufacturer's invoice cost up to $100 Manufacturer's invoice cost up to $30 Manufacturer's invoice cost up to $25 H500

H515 H550 H555 H560

Frequency Modulation (FM) or Digital Modulation (DM) System FM/DM Fitting Fee

Major Repair to FM/DM (Same conditions as H140)

Service Fee for major FM/DM repairs (Same conditions as H145) FM/DM Return Fee (cannot be billed unless device trialed and returned)

1/5 years 1/5 years

1/yr per component to maximum of 3/year 1/yr per component to maximum of 3/year 1/5 years

Manufacturer's invoice cost up to $1,900 $450

Manufacturer's invoice to a max. of $300 $70

$75

1. The Return Fee is a flat rate fee which includes the cost of the assessment, earmold and service fee. No extra billing on fees is permitted.

2. H722 (CROS hearing aid) or H723 (Bi-CROS hearing aid) will always be billed in conjunction with H724 (CROS/Bi-CROS microphone). 3. The service fee of $40 is available to all AADL Clients who are having their earmold replaced after 1 year of use. No extra billing on fees

is permitted.

4. The service fee on repairs is available to all AADL Clients. No extra billing on fees is permitted. Service certificates and manufacturers' invoices must be kept on file. The service fee may be claimed in the final year of a manufacturer's two year warranty. Should the aid require repair in the following year, both the service and repair fees may be claimed regardless of when the repair occurs. Following this, the fees cannot be claimed for twelve months from the date of service. After the fourth year, a six-month warranty is acceptable. This applies to AADL Clients of all ages.

5. CROS/BICROS repairs can bill one major repair fee for the hearing aid/receiver and transmitter to a maximum of $300. CROS/BICROS hearing aid repairs can only bill one service fee to a maximum of $70. Enter one major repair fee and one service fee in E-business with serial numbers in benefit notes.

(12)

SCHEDULE A

BONE ANCHORED HEARING DEVICES

APPROVED PRODUCT LIST

EFFECTIVE JULY 1, 2013

Subject to COST SHARE

AADL

CAT # DESCRIPTION OF PRODUCT/SERVICE

FREQUENCY

LIMIT MANUFACTURER’S MAXIMUM INVOICE COST

H900 Bone Anchored Hearing Device 1/6 years per affected ear $4,100.001,2

H910 Bone Anchored hearing Device Repair 1 per year per affected ear $500.00

1. Bone Anchored Hearing Device with Softband - Maximum AADL funding - $4100 2. Bone Anchored Hearing Device - Maximum AADL funding - $3850

(13)

SCHEDULE A

COCHLEAR IMPLANTS

APPROVED PRODUCT LIST

EFFECTIVE JULY 1, 2014

Subject to COST SHARE

AADL

CAT # DESCRIPTION OF PRODUCT/SERVICE

FREQUENCY

LIMIT MANUFACTURER’S MAXIMUM INVOICE COST

H800 Cochlear Implant External Processor 1/7 years per affected ear $10,000.00

H810 Cochlear Implant Repairs 1 per year per affected ear $2,000.00

References

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