Model Bill: Insurance Coverage of Hearing Aids for Children

1. 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.
   
   
2. This section shall apply to the following entities:
   
   
   1. 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.
      
      
   2. 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.
      
      
3. 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.
   
   
   1. 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.
      
      
   2. 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.
      
      
   3. 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. 
      
      
4. 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.
   
   
5. 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 or participant.

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 practices.