Bill Text: GA HB1061 | 2011-2012 | Regular Session | Introduced

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Bill Title: Hearing Aid Coverage for Children Act; enact

Spectrum: Partisan Bill (Republican 4-0)

Status: (Introduced - Dead) 2012-02-21 - House Second Readers [HB1061 Detail]

Download: Georgia-2011-HB1061-Introduced.html

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12 LC 37 1380

House Bill 1061

By: Representatives Lindsey of the 54th, Holt of the 112th, Wilkinson of the 52nd, and Watson of the 163rd

A BILL TO BE ENTITLED
AN ACT

To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating generally to insurance, so as to provide for a short title and findings; to require health plans to provide coverage for hearing aids for certain individuals; to provide for the frequency of replacement of hearing aids; to provide for coverage of services and supplies; to provide options for higher priced devices; to provide for related matters; to repeal conflicting laws; and for other purposes.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

SECTION 1.

Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating generally to insurance, is amended by adding a new Code section to read as follows:

"33-24-59.16.

(a) This Code section shall be known and may be cited as the 'Hearing Aid Coverage for Children Act.'

(b) The General Assembly finds and declares that:

(1) The language development of children with partial or total hearing loss may be impaired due to the hearing loss. Children learn the concept of spoken language through auditory stimuli, and the language skills of children who have hearing loss improve when they are provided with hearing aids and access to visual language upon the discovery of hearing loss; and

(2) Providing hearing aids to children with hearing loss will reduce the costs borne by this state, including special education, alternative treatments that would otherwise be necessary if a hearing aid were not provided, and other costs associated with such hearing loss.

(c) As used in this Code section, the term:

(1) 'Health benefit policy' means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, or renewed in this state which provides major medical benefits, including those contracts executed by the State of Georgia on behalf of indigents and on behalf of state employees under Article 1 of Chapter 18 of Title 45, by a health care corporation, health maintenance organization, preferred provider organization, accident and sickness insurer, fraternal benefit society, hospital service corporation, medical service corporation, or any similar entity and any self-insured health care plan not subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Sec. 1001, et seq.

(2) 'Hearing aid' means any nonexperimental and wearable instrument or device offered to aid or compensate for impaired human hearing that is worn in or on the body. The term 'hearing aid' includes any parts, ear molds, repair parts, and replacement parts of this instrument or device including, but not limited to, nonimplanted bone anchored hearing aids, nonimplanted bone conduction hearing aids, and frequency modulation systems. Personal Sound Amplification Devices (PSAP's) shall not qualify as hearing aids. Any hearing devices that are preprogrammed prior to a fitting shall not qualify as hearing aids. Any hearing devices that are preprogrammed and sent directly to the patient prior to a fitting shall not qualify as hearing aids.

(d) Every health benefit policy that is delivered, issued, executed, or renewed in this state or approved for issuance or renewal in this state by the Commissioner on or after July 1, 2012, shall provide coverage for the full cost of one hearing aid per hearing impaired ear subject to a $2,500.00 minimum and up to $3,000.00 per hearing aid for covered individuals 22 years of age or under. Such coverage shall provide the replacement for one hearing aid per hearing impaired ear every 36 months for covered individuals. This section does not prohibit an entity subject to this section from providing coverage that is greater or more favorable to an insured or enrolled individual than the coverage required under this Code section.

(e) In the event that a hearing aid or aids cannot adequately meet the needs of the covered individual and the hearing aid or aids cannot be adequately repaired or adjusted, the hearing aid or aids shall be replaced. Coverage for the replacement shall be offered within two months from the date it is determined that the aid or aids cannot be repaired or adjusted.

(f) The coverage provided by this Code section shall include the following:

(1) Services and supplies including, but not limited to, the initial hearing aid evaluation, fitting, dispensing, programming, servicing, repairs, follow-up maintenance, adjustments, supplies including ear molds, ear mold impressions, auditory training, and probe microphone measurements to ensure appropriate gain and output, as well as verifying benefit from the system selected according to accepted professional standards. Such services shall be covered on a continuous basis, as needed during each 36 month coverage period or for the duration of the hearing aid warranty, whichever time period is longer;

(2) An option for the covered individual to choose a higher priced hearing aid or aids and to pay the difference between the price of the hearing aid and the benefit amount as referenced above, without financial or contractual penalty to the insured or to the provider of the hearing aid; and

(3) An option for the covered individual to purchase his or her hearing aid or aids through any licensed audiologist or licensed hearing aid dealer or dispenser in this state.

(g) A health insurance plan may not deny or refuse coverage of, refuse to contract with, or refuse to renew or refuse to reissue or otherwise terminate or restrict coverage of a covered individual solely because he or she is or has been previously diagnosed with hearing loss.

(h) The benefits covered under this Code section shall be subject to the same annual deductible, coinsurance or copayment, or utilization review applicable to other similar covered benefits under the health benefit policy."

SECTION 2.

All laws and parts of laws in conflict with this Act are repealed.