Model Bill: Insurance Coverage of Hearing Aids for Children
- As used in this section, "hearing aid" shall mean
a nondisposible device that is of a design and circuitry to
optimize audition and listening skills in the environment
commonly experienced by children.
- This section shall apply to the following entities:
- Insurers and nonprofit health service plans, including
the office of group benefits, that provide hospital, medical,
or surgical benefits to individuals or groups on an
expense-incurred basis under health insurance policies or
contracts that are issued or delivered in this state.
- Managed care organizations as defined and licensed by
state law that provide hospital, medical or surgical benefits
to individuals or groups under contracts that are issued or
delivered in this state.
- An entity subject to this Section shall provide coverage
for hearing aids for a child under the age of eighteen who is
covered under a policy or contract of insurance if the hearing
aids are fitted and dispensed by a licensed audiologist
certified by the American Speech-Language-Hearing Association
following medical clearance by a physician licensed to practice
medicine and an audiological evaluation medically appropriate
to the age of the child.
- An entity subject to this section may limit the benefit
payable under Paragraph (1) of this subsection to one
thousand and five hundred dollars per hearing aid for each
hearing-impaired ear every thirty-six months.
- An insured or enrolled individual may choose a hearing
aid that is priced higher than the benefit payable under this
Subsection and may pay the difference between the price of
the hearing aid and the benefit payable under this Subsection
without financial or contractual penalty to the provider of
the hearing aid.
- In the case of a health insurer or managed care
organization that administers benefits according to contracts
with health care providers, hearing aids covered pursuant to
this section shall be obtained from health care providers
contracted with the health insurer or managed care
organization. Such providers shall be subject to the same
contracting and credentialing requirements that apply to
other contracted health care providers.
- This section does not prohibit an entity subject to the
provisions of this section from providing coverage that is
greater or more favorable to an insured or enrolled individual
that the coverage required under this section.
- The provisions of this section shall apply to any new
policy, contract, program, or plan issued by an entity subject
to the provisions of this section on or after January 1, 200-.
Any such policy, contract, program or plan in effect prior to
January 1, 200- shall convert to the provisions of this section
on or before the renewal date thereof but in no event later
than January 1, 200-. Any policy affected by the provisions of
this section shall apply to an insured or participant under
such policy, contract, program, or plan whether or not the
hearing impairment is a pre-existing condition of the insured
Note: Insurance laws vary considerably from state to state
in the format and detail required. This model bill may need to
be modified significantly to meet individual state