protection plus

Coverage Effective Date
Coverage will be effective from the date of
postmark, providing all required information
is received. If your application is incomplete,
coverage will be effective when all necessary
information is received.
Renewal
Your benefits can be renewed annually while in
Manufacturer Repair Warranty Period. We will
notify you before your benefits expire.
Definitions, Terms And Limitations
This brochure provides a summary of items
regarding the Unitron Protection Plus Insurance
Plan.
• Accidental damage means unintentional
physical damage sustained by your instruments.
• Gradual deterioration, normal wear
and tear, and electronic failure are NOT
covered by this policy.
• If we replace your instruments, we will
notify you regarding new coverage for
your replaced instruments.
Submitting A Claim
To submit a claim, send a completed and
signed claim form to ESCO via mail or
FAX (800-894-6056). Claim forms can be obtained at
www.unitron.earserv.com or by contacting ESCO at
800-992-3726 or from your practitioner.
Hearing instruments are sophisticated electronic
devices that require specialized professional services
only your practitioner can provide. ESCO and your
practitioner work together to provide you the best
possible solution should a replacement or repaired
device be required.
PROTECTION PLUS
Act now to ensure that you have loss
and accidental damage protection for
your Unitron hearing instuments.
Note: This policy does not cover any fee that may be
charged for professional services performed by your
practitioner in the event of a claim.
Veterans
If you have used Veterans Administration hearing
benefits for these hearing instruments, please
disregard this extended insurance coverage offer.
Replacement coverage is managed through the
Veterans Administration.
For more information,contact us at
1-800-992-3726
3215 Fernbrook Lane N • Plymouth, MN 55447
www.earserv.com
Annual Insurance Policy
028-5546-03
Loss and Accidental
Damage Insurance
Enrollment Options
Enrolling Online:
Quick and Easy way to get Enrollment Online. Apply
online at: www.unitron.earserv.com/enroll
Mailing or FAXING an Application:
1. Complete and sign the Policy Holder Information
on the attached application.
2. Bring your hearing instruments to your practitioner
for an inspection. Your practitioner will then complete
the Hearing Instrument Information section.
3. Send the completed application and your annual
Protection Plus payment to ESCO within thirty days of
your practitioner’s inspection.
Note: Your practitioners signature is not required if you are
submitting this application within 60 days of receiving your
replacement hearing instruments.
4. Once processing is complete, confirmation
of coverage will be sent to you within seven
business days.
Unitron models by technology level
Premium
North Moxi Pro, Quantum Moxi2 Pro,
Quantum Moxi2 20
$189
North Moxi 800, Quantum Moxi2 16,
Max 20
North Moxi 700, North Moxi 600,
North Moxi 500 , Quantum Moxi2 E,
Quantum Moxi2 10, Shine +, Max 6
$149
$129
Trusted protection.
Enrolling online is easy! Get set up today by visiting: www.unitron.earserv.com/enroll
1>
Policy Holder Information
Wearer Name
2>
Mailing Address
Guardian Name (if applicable)
City/State/Zip
E-Mail Address
Wearer Date of Birth
Daytime Phone Number
Wearer or Guardian’s Signature
I elect coverage on the instruments listed.
Wearer or Guardian Signature (Manditory)
These people are authorized to discuss my coverage
Style:BTE RIC ITC HS
ITE CIC MC Other
Manufacturer
Model
Serial #
Date of
Replacement
Date of Manufacturer
Warranty Expiration
Unitron
Right Aid
Right Aid
Month/Day/Year
Loss
Unitron
Left Aid
Left Aid
Month/Day/Year
Loss
$
Repair
Total Amount Due
Practitioner Information
3>
Office Name:
Premium
$
Repair
$
I wish to pay by:
Check made payable to ESCO
Credit Cards accepted:
Address:
(Visa, MasterCard, American Express and Discover)
City, State, Zip:
Pricing
EAR SERVICE CORPORATION
Phone Number:
Name on Card:
ESCO Center Number (if available):
Card #:
Expiration Date:
Practitioners Signature
This step is not required if you are submitting an application
within 60 days of receiving replacement hearing instruments.
I have examined the listed hearing instruments and certify they are
in good working condition on the date shown below.
Practitioner Signature
(Inspection valid for 30 Days)
Date
Enrollment Options:
Online at www.unitron.earserv.com/enroll
Mail this completed application and payment to:
Unitron/ESCO, 3215 Fernbrook Lane, Plymouth, MN 55447
FAX this form with your credit card information to
ESCO at 763-559-4247
Unitron/ESCOProtectionPlus-ESC-PP 9/15
When you enroll in this program your Unitron
instruments will be covered for:
• Replacement of your instruments if they are lost.
• Repair or replacement if your instruments are accidentally damaged.
esco
ESCO PROTECTION PLUS - Unitron
Application For Hearing Instrument Coverage
BROC1011-00-EE
The ESCO Protection Plus policy
is insurance coverage for your
Unitron hearing instruments.