Hearing aid exceptional circumstance criteria

Aids that exceed the schedule

The new schedule of fees has an up-to amount of $2,415 per aid (GST included).

The aid that is recommended and fitted by the audiologist will be at their clinical discretion based on the veterans needs.

If the aids that are being recommended by the audiologist are over $2,415 per aid (GST included), then the audiologist needs to first discuss this with the veteran to see if they are able to self-fund the difference. If the veteran is unable to self-fund, or they meet the below criteria for exceptions, then the audiologist is to complete the exceptional circumstances application form and send this to the veteran's case manager for consideration by an independent audiologist.

Hearing exceptional circumstances form [PDF, 360 KB]

Criteria:

• The veteran is working in a safety critical role that requires higher tech aids to maintain the veteran’s safety
• Evidence the veteran has trialled and failed lower tech aids due to the nature of the complexity of their hearing loss
• The degree of hearing loss / speech discrimination / asymmetrical hearing loss / medical conditions mean lower tech aids are not going to be appropriate to meet their hearing needs.

Early replacement aids

Veterans with hearing loss as an accepted condition are entitled to funding for a new set of aids every six years.

If the veteran has been assessed by the audiologist and the current aids are no longer fit for purpose they can apply to Veterans’ Affairs for an early replacement of the aids using the exceptional circumstances form. This excludes veterans who request new aids due to losing or neglecting their aids or those veterans who want updated technology.

Hearing exceptional circumstances form [PDF, 360 KB]

Criteria:

• There is evidence of severe deterioration in the veteran’s hearing, and therefore they require a new set of aids to meet their needs

Or

• The veteran has had a significant change in their circumstances which means the current aids are no longer meeting their needs (like if their work situation changes).

And

• There is evidence the audiologist has considered repairs or adjustments to make the current aid meet the needs of the veteran, but these have not been successful, or it is not economical to do so.

Beyond economical repair includes aids that are five years old and the cost of the repairs is more than 60% of the cost of a new set of aids.
If still within the warranty period, the manufacturer is required to meet the cost of any repairs.

Accessories

We will cover the costs of a charger and an electronic drying kit if these are required to ensure the new hearing aids will be functional for the veteran. These costs are built into the schedule of fees and can be supplied by the audiologist without pre-approval as part of the setup costs.

Hearing aid schedule of fees

We may cover the cost of additional accessories to meet the needs of the veteran, but these will require pre-approval. The audiologist will need to complete the exceptional circumstances request form to outline what is recommended and give clinical reasoning as to why the accessory is needed.

Hearing exceptional circumstances form [PDF, 360 KB]

Criteria:

• The veteran is employed and requires the accessory to meet their employment needs (for example, to be effective in meetings)
• There is evidence the veteran has trialled and failed lower tech aids due to the nature of the complexity of their hearing loss they require an additional accessory
• The degree of hearing loss / speech discrimination / asymmetrical hearing loss / medical conditions means the veteran would benefit from an accessory to supplement their aids to meet their hearing-related goals.