Hearing Aid Insurance Legislation Update

A second bill has been introduced in New Jersey, Bill S1664. Essentially the bill provides that every group and individual health policy issued in the State, "shall provide coverage for medically necessary expenses incurred in the purchase of a hearing aid for a covered person 18 years of age or younger. A carrier shall provide coverage which includes the purchase of a hearing aid for each ear at such intervals as a medical provider determines to be medically necessary or appropriate and as prescribed or recommended by those providers as the medical provider deems appropriate." That language is pretty broad and favorable to the HOH person, with the only limitation being that the person must be 18 years old or younger. The language provides for an aid for each ear as often as a doctor, audiologist or HAD says that a new one is necessary. That is a very good clause. The term "medically necessary" is insurance jargon for a minimum standard of need -- essentially if a doctor or audiologist or HAD says you need a hearing aid then the insurance company will accept that as meeting the requirement for "medical necessity". Each paragraph of the Bill S1664 also contains a statement at the end, "The benefits shall be provided to the same extent as for any other medical supplies or equipment under the policy." This last statement of each paragraph may limit the coverage to whatever limits of coverage may be for "durable medical equipment" under the individual's policy, and consequently subject to the same deductible. If that is correct, that would mean that the insurer would pay the stated percentage of coverage in the same manner as for durable medical equipment with respect to the cost of the aid up to the policy limit, subject to the applicable co-payment which would be the same percentage for any other type of durable medical equipment. For example, if a person's policy covers durable medical equipment up to the extent of 80% of the cost not to exceed a total coverage of $1500, then if an insured bought an aid for $1500, the policy would pay $1200, and the insured would pay $300. The problem with this statement that has been added at the end of each paragraph is that it does not specifically provide that the limit of coverage applies to each aid separately. Under the example given above, if an insured need two aids, each costing $1500 for a total cost for 2 aids of $3000, the language could be read as requiring that the insurance company would pay only $1500 in total for both aids rather than $1200 per aid with the insured paying $300 per aid. A clarification of this language is needed so that the limits of coverage for durable medical equipment apply to each aid separately so that in the example above the insurer would pay $2400 and the insured would pay only $600.

A Bill has reportedly been passed by the New Jersey Senate which would provide coverage of up to $1,000.00 every two (2) years for people up to 18 years of age. A review of the New Jersey Legislature's web site does not reveal this Bill, and therefore, it must be reported as unconfirmed as of this writing.

The Oregon Bill (House Bill 3185), which died in committee provided for a hearing aid for each hearing-impaired ear. Coverage was limited to the sum of $1,200.00 every 48 months for each hearing-impaired ear.

In New York, there were two identical bills, one in the Senate (Senate Bill S5692A) and one in the Assembly (Assembly Bill A8896A). Both bills provided for anyone 16 years of age or older to receive $1,000.00, every three (3) years for hearing aids, and anyone 15 years of age or younger would receive $1,000.00 every two (2) years, except that for a child 15 years or younger the time limitation would not apply in the event a change in hearing loss required a change in hearing aids. The $1,000.00 limit for both groups was not subject to reduction for any co-payment, deductible or coinsurance.

The Bill pending in Ohio (H. B. No. 110) is a generous bill. An insurer would be required to pay 50% of the cost of hearing aids, which reimbursement would not be reduced by any co-payment. However, the bill does not specify if it applies to one or two hearing-impaired ears and there is not time limit set within which the aids could be replaced and be covered under the insurance. Thus, an insurer could set its own time limit or even limit it to a one-time only coverage.

The Bill that was proposed in Colorado (House Bill 02-1220) only applied to children under the age of 16 and provided for "hearing aids" every five years. There was no limit on the amount the aids might cost and no statement as to whether the coverage applied to only one or two hearing-impaired ears. The Bill did provide that if the child needed new aids sooner than five (5) years as a result of a change in the child's condition, additional coverage would be available.

In Connecticut a general "statement of purpose" bill (Raised Bill No. 136) was introduced in an effort to expand the coverage that was previously passed. Under current Connecticut law a child under the age of 13 is entitled to reimbursement of $1,000.00 every two (2) years. The CT HAIL Coalition did support expanding the current mandate, but did not want to risk a revocation of the current law with a strong push this year for broader coverage. In addition, it was felt that the Connecticut legislature would not expand coverage beyond its current level without seeing a history of cost and benefit under the legislation that was passed in 2001.

The Bill proposed in Pennsylvania in 2001 (House Bill 961) is what is referred to a "statement of purpose" or "place holder" bill, which introduces a general matter for consideration by the state legislature. The Pennsylvania bill provides no specific details as to the coverage that might be available.

In Minnesota, two different bills were introduced in each chamber, one bill providing that the term "covered expense' as used in an insurance policy would mean any expense to purchase or rent for a hearing aid for any individual under the age of 21 years (H. F. No 1312 and S. F. No 1216). The second bill (H. F. No. 221 and S. F. No. 186) would have provided coverage for hearing aids, "for persons over age 18 with a documented hearing loss no greater than 25 dBHTL based on an audiometric threshold test using the pure tone average" (emphasis added). Both bill forms died in Committee.