What's happening
This bill requires large group health insurance policies in New York to cover medically necessary hearing aids for both adults and children.
Why it matters
Improves access to hearing aids for adults and children. by requiring large group health insurance plans to cover substantial costs—up to $3,000 every three years for adults and $2,000 every two years for children, reducing out-of-pocket expenses and making hearing aids more affordable.
Addresses changing medical needs for children. by allowing additional reimbursement if a child’s hearing changes significantly and their current device becomes inadequate, helping families adapt as children grow and their hearing needs shift.
Defines what is covered. by including not just the hearing aids themselves, but also necessary parts, attachments, recasing, reshelling, and new molds—ensuring comprehensive coverage for common maintenance and fitting needs (though batteries and cords are excluded).
Balances patient choice and cost control. by permitting individuals to select more expensive hearing aids if desired, while making them responsible for costs above the required reimbursement, and allowing insurers to apply typical plan features like deductibles and coinsurance.
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Who cares
Headline styles
Cover Hearing Aids in Insurance
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
501
2019-2020 Regular Sessions
IN ASSEMBLY (Prefiled)
January 9, 2019
Introduced by M. of A. PAULIN -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring certain group health insurance policies to provide coverage for hearing aids
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 3221 of the insurance law is amended by adding a new subsection (t) to read as follows:
(t) (1) Every group health insurance policy offered in the large group market that is issued, amended, or renewed in this state shall provide coverage for medically necessary hearing aids purchased from a hearing aid dispenser registered under article thirty-seven-A of the general business law or an audiologist licensed under article one hundred fifty-nine of the education law in the following manner:
(A) For an insured person sixteen years of age or older, such insured person shall be entitled to reimbursement of up to three thousand dollars every thirty-six months for expenses related to the purchase of up to two hearing aids.
(B) For an insured person who is less than sixteen years of age, such insured person shall be entitled to reimbursement of up to two thousand dollars every twenty-four months for expenses related to the purchase of up to two hearing aids, when it is medically demonstrated that:
(i) the hearing of the insured person under the age of sixteen has changed significantly within a two-year period; and
(ii) the existing hearing aid will no longer correct the hearing of the insured person under the age of sixteen; such person shall be entitled to reimbursement for additional hearing aid expenses.
(2)(A) For the purposes of this subsection, "hearing aid" shall mean any wearable instrument or device designed for hearing and any parts, attachments or accessories but excluding batteries and cords or accesso-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03704-01-9
A. 501 2
ries thereto. A registered hearing aid dispenser or licensed audiologist shall determine the type of device needed to correct the hearing loss.
(B) For the purposes of this section, services for recasing, reshelling and acquiring new molds shall be included as part of the policies.
(3) The insured person may choose a hearing aid exceeding the amount of coverage required by this section and shall be liable for the difference in cost. Reimbursement shall be provided according to the respective principles and policies of the health insurance plan and may include such policy provisions as deductibles, coinsurance, allowable charge limitations, and coordination of benefits.
§ 2. Section 4305 of the insurance law is amended by adding a new subsection (n) to read as follows:
(n) (1) A group contract issued, amended, or renewed pursuant to this section offered in the large group market shall provide coverage for medically necessary hearing aids purchased from a hearing aid dispenser registered under article thirty-seven-A of the general business law or an audiologist licensed under article one hundred fifty-nine of the education law in the following manner:
(A) For an insured person sixteen years of age or older, such insured person shall be entitled to reimbursement of up to three thousand dollars every thirty-six months for expenses related to the purchase of up to two hearing aids.
(B) For an insured person who is less than sixteen years of age, such insured person shall be entitled to reimbursement of up to two thousand dollars every twenty-four months for expenses related to the purchase of up to two hearing aids, when it is medically demonstrated that:
(i) the hearing of the insured person under the age of sixteen has changed significantly within a two-year period; and
(ii) the existing hearing aid will no longer correct the hearing of the insured person under the age of sixteen; such person shall be entitled to reimbursement for additional hearing aid expenses.
(2)(A) For the purposes of this subsection, "hearing aid" shall mean any wearable instrument or device designed for hearing and any parts, attachments or accessories but excluding batteries and cords or accessories thereto. A registered hearing aid dispenser or licensed audiologist shall determine the type of device needed to correct the hearing loss.
(B) For the purposes of this section, services for recasing, reshelling and acquiring new molds shall be included as part of the policies.
(3) The insured person may choose a hearing aid exceeding the amount of coverage required by this section and shall be liable for the difference in cost. Reimbursement shall be provided according to the respective principles and policies of the health insurance plan and may include such policy provisions as deductibles, coinsurance, allowable charge limitations, and coordination of benefits.
§ 3. This act shall take effect on the ninetieth day after it shall have become a law and shall apply according to its terms to all policies, contracts and certificates issued, renewed, modified, altered or amended on or after such date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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