may need advance approval from your plan. This is called a"prior authorization" or "preauthorization." Please 
contact your PCP or refer to the Evidence of Coverage (EOC) for services that require aprior authorization from the 
plan .
c
H5619075000SB23 Summary of Benefits 9H5619075000 
Covered Medical and Hospital Benefits  (cont.) 
N/A WHAT YOU PAY ON THIS HUMANA PLAN 
•$0 copay for each Advanced level hearing aid up to 1per ear every  
3years.  
Hearing aid purchase includes: