What's happening
This bill requires health insurers in New York to provide coverage for children's hearing aids, up to $3,000 per ear every 24 months.
Why it matters
Reduces barriers to early intervention for children with hearing loss. by ensuring insurance covers a significant portion of hearing aid costs, which is crucial for language and cognitive development during formative years.
Standardizes access across insurance types. (including managed care, group, and individual policies), helping to ensure that all insured children in New York, regardless of the specific plan, can benefit from this coverage.
Allows families flexibility and choice. by permitting parents to select higher-priced hearing aids and pay the difference without penalty, supporting individualized needs and preferences without restricting access due to insurance caps.
Eliminates pre-existing condition exclusions for hearing impairment. for covered hearing aid benefits, ensuring children are not denied this essential support based on when hearing loss was identified or diagnosed.
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Who cares
Headline styles
Require Insurance for Hearing Aids
Plain English, a few words. Used as the page title.
Sponsors
4 Co-sponsors
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Require Insurance for Hearing Aids
In Assembly Committee · Insurance · Sponsor Michaelle C. Solages
Full text
4 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
5495
2019-2020 Regular Sessions
IN SENATE
May 3, 2019
Introduced by Sens. PERSAUD, SKOUFIS -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to the mandatory coverage of hearing aids by insurers and other organizations
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 36 to read as follows:
(36) (A) As used in this paragraph, "hearing aid" shall mean a nondisposable device that is of a design and circuitry to optimize audition and listening skills in the environment commonly experienced by children.
(B) This paragraph shall apply to the following entities:
(i) 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.
(ii) 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.
(C) An entity subject to this paragraph shall provide coverage for hearing aids for patients who are 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, provided:
(i) an entity subject to this paragraph may limit the benefit payable under this paragraph to three thousand dollars per hearing aid for each hearing-impaired ear every twenty-four months.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05146-03-9
S. 5495 2
(ii) an insured or enrolled individual may choose a hearing aid that is priced higher than the benefit payable under this paragraph and may pay the difference between the price of the hearing aid and the benefit payable under this paragraph without financial or contractual penalty to the provider of the hearing aid.
(iii) 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 paragraph 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.
(D) This paragraph does not prohibit an entity subject to the provisions of this paragraph from providing coverage that is greater or more favorable to an insured or enrolled individual than the coverage required under this paragraph.
(E) The provisions of this paragraph shall apply to any new policy, contract, program, or plan issued by an entity subject to the provisions of this paragraph on or after January first, two thousand twenty-one. Any such policy, contract, program or plan in effect prior to January first, two thousand twenty-one shall convert to the provisions of this paragraph on or before the renewal date thereof but in no event later than January first, two thousand twenty-one. Any policy affected by the provisions of this paragraph 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.
§ 2. Section 3221 of the insurance law is amended by adding a new subsection (u) to read as follows:
(u) (1) As used in this subsection, "hearing aid" shall mean a nondisposable device that is of a design and circuitry to optimize audition and listening skills in the environment commonly experienced by children.
(2) This subsection shall apply to the following entities:
(A) 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.
(B) 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 subsection shall provide coverage for hearing aids for patients who are 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, provided:
(A) An entity subject to this subsection may limit the benefit payable under this subsection to three thousand dollars per hearing aid for each hearing-impaired ear every twenty-four months.
(B) 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 payably under this subsection without financial or contractual penalty to the provider of the hearing aid.
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(C) 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 subsection 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 subsection does not prohibit an entity subject to the provisions of this subsection from providing coverage that is greater or more favorable to an insured or enrolled individual than the coverage required under this subsection.
(5) The provisions of this subsection shall apply to any new policy, contract, program, or plan issued by an entity subject to the provisions of this subsection on or after January first, two thousand twenty-one. Any such policy, contract, program or plan in effect prior to January first, two thousand twenty-one shall convert to the provisions of this subsection on or before the renewal date thereof but in no event later than January first, two thousand twenty-one. Any policy affected by the provisions of this subsection 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.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (ss) to read as follows:
(ss)(1) As used in this subsection, "hearing aid" shall mean a nondisposable device that is of a design and circuitry to optimize audition and listening skills in the environment commonly experienced by children.
(2) This subsection shall apply to the following entities:
(A) 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.
(B) 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 subsection shall provide coverage for hearing aids for patients who are 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, provided:
(A) An entity subject to this subsection may limit the benefit payable under this subsection to three thousand dollars per hearing aid for each hearing-impaired ear every twenty-four months.
(B) An insured or enrolled individual may choose a hearing aid that is priced higher then the benefit payable under his 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.
(C) In the case of the health insurer or managed care organization that administers benefits according to contracts with health care providers, hearing aids covered pursuant to this subsection shall be obtained from health care providers contracted with the health insurer or managed care organization. Such providers shall be subject to the
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same contracting and credentialing requirements that apply to other contracted health care providers.
(4) This subsection does not prohibit an entity subject to the provisions of this subsection from providing coverage that is greater or more favorable to an insured or enrolled individual than the coverage required under this subsection.
(5) The provisions of this subsection shall apply to any new policy, contract, program, or plan issued by an entity subject to the provisions of this subsection on or after January first, two thousand twenty-one. Any such policy, contract, program or plan in effect prior to January first, two thousand twenty-one shall convert to the provisions of this subsection on or before the renewal date thereof but in no event later than January first, two thousand twenty-one. Any policy affected by the provision of this subsection 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.
§ 4. This act shall take effect on the ninetieth day after it shall have become a law. Effective immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date are authorized to be made and completed on or before such date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to the mandatory coverage of hearing aids by insurers and other organizations
Purpose
To require all managed care organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued in this state to provide coverage for hearing aids for children under the age of eighteen.
Summary of provisions
Section 1. Subdivision (i) of section 3216 of the insurance law is amended by adding a new paragraph 34 to read as follows:
Read the full memo (889 words)
(A) As used in this paragraph, "hearing aid" shall mean a non-disposable device that is of a design and circuitry to optimize audition and listening skills in the environment commonly experienced by children.
(B) This paragraph shall apply to the following entities: (i) Insurers and nonprofit health service plans, including the office of group bene- fits, that provide hospital, medical, or surgical benefits to individ- uals or groups on an expense-incurred basis under health insurance poli- cies or contracts that are issued or delivered in this state.
(ii) 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.
(C) An entity subject to this paragraph shall provide coverage for hear- ing 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, provided.
(i) an entity subject to this paragraph may limit the benefit payable under this paragraph to one thousand and five hundred dollars per hear- ing aid for each hearing-impaired ear every thirty-six months.
(ii) an insured or enrolled individual may choose a hearing aid that is priced higher than the benefit payable under this paragraph and may pay the difference between the price of the hearing aid and the benefit payable under this paragraph without financial or contractual penalty to the provider of the hearing aid.
(iii) 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 paragraph 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.
(D) This paragraph does not prohibit an entity subject to the provisions of this paragraph from providing coverage that is greater or more favor- able to an insured or enrolled individual than the coverage required under this paragraph.
Existing law
Currently insurance is not required to cover hearing aids for children.
Justification
This legislation seeks to offer insurance coverage for hearing aids by all insurers, non-profit health plans, and managed care organizations to provide funding for the purchase of hearing aids and hearing aid related services for all patients 18 years and younger.
A 2017 survey by the Hearing Health Foundation, a group that funds research and advocates for treatments and cures for hearing loss, found that 40 percent of the people they asked had no hearing aid coverage through health insurance. Currently, 13 states, including Colorado, Delaware, Georgia, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Missouri, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Tennessee, and Texas require that health benefits plans in their state pay for hearing aids for children. Arkansas, Connecticut, Illi- nois, New Hampshire and Rhode Island also require health plans to pay for hearing aids, regardless of age. 19 states in total mandate the coverage of hearing aids in some form.
Studies provided by the Center for Hearing and Communication elucidate that hearing loss occurs in 5 out of every 1,000 newborns. Children ages 18 and under are subject to the greatest physical growth of their whole life. Constant growth through puberty can leave them with outstanding balances from purchasing hearing aids when they suffer from hearing loss. Not only can the potential outstanding balances affect the chil- dren in our community, but also can affect their studies and future success. The Center for Hearing and Communication also state that a mild hearing loss can cause a child to miss as much as 50% of classroom discussion. It is imperative to ensure insurance coverage for our young- est community.
Additionally, providing hearing aids to children stands to save the state money over the long run. According to the 2017 Annual Report on the Children's Hearing Aid Program, published by the Utah Department of Health: "The provision of hearing aids in eligible young children reduces the need for long term services. Research has shown that the earlier a child can be fit with appropriate amplification, the greater the potential for typical speech and language development, social skills, academic achievement, and future vocational skills. Early ampli- fication and appropriate Early Intervention services save significant costs associated with special education services and the potential need for long term services, thereby reducing financial burden on the public."
Legislative history
S6894- Valesky (Died in Insurance)
Fiscal implications
Undetermined.
Effective date
90th Day
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.