Apply For Coverage

Getting a quote and applying for coverage is easy. All we need is your address (applicant’s address), your hearing instrument information, what type of coverage you are applying for, and finally, how you want to pay for your coverage. That’s it.

Take a moment to review your coverage details and device details below. If everything is correct, click the “Pay” button to complete your renewal. If you need to make changes, such as changing your devices or coverage type, please give us a call at 1-800-992-3726. We'll update your policy over the phone.

Policy Holder:
Address:
Phone:
Email:
Policy ID:
Policy Effective Date:
Policy Expiration Date:
Policy Coverage Code:
Policy Premium:


Device List

DEVICE MANUFACTURER MODEL PURCHASE DATE SERIAL NUMBER DEVICE PREMIUM
Pay

Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and (NY: Substantial) civil penalties. (Not applicable in CO, HI, NE, OH, OR, or VT; in DC, LA, ME, TN and VA, inccurence benefits may also be denied.)

Patient Information



Practitioner

Please select your practitioner from the list below. The list is sorted alphabetically by city.

*ESCO’s coverage is for the hearing instruments only. Your practitioner may charge co-payments for office related services.


Build your ESCO Policy Quote

Select the information below and click “Add to Quote” for each device you wish to add to your ESCO application quote. Don't know your device style?

If you would like us to verify your selections, check the "Verify my selections" box below. We'll call the manufacturer on your behalf and make sure everything is correct. Please note: pricing does vary based on style.

Click here to review our style guide.

Add a Device





Would you like to sign up for Auto Renew?

Automatic renewals ensure continuous coverage year after year.
  • Auto-renew adds convenience to paying got your renewal each year.
  • Your Auto-renew account keeps your payment information safe and secure. You can access and change your payment information online, anytime.
  • Our support team is dedicated to serving you. If you have a question about your account, or your policy, call us toll-free at 800-992-3726. You can also contact technical support are info@earserv.com

Your account is created by ESCO, and secured by Authorize.net, a leading provider of secure, online payments.


Please review the following information





Sworn Statement

Please read the following, and check the box for acknowledgement.



Edit Pay
(Total:: $.)

Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and (NY: Substantial) civil penalties. (Not applicable in CO, HI, NE, OH, OR, or VT; in DC, LA, ME, TN and VA, inccurence benefits may also be denied.)

Select Payment Method

Credit Card eCheck

Pay with Card

Total Amount due today: .

Proceed with Payment

Esco Logo
Success! Your payment has been processed and your policy has been created.

Your hearing aids are covered with ESCO!

Your payment has been processed and your Policy has been submitted.

Aid information

Coverage selection

Policy ID:
Policy Effective Date:
Policy Expiration Date:

Payment

This is your receipt of payment. We suggest you print this document for your records. Your policy will be sent to you in 7-10 business days. You can also download it below.