Bill Text: NY A02325 | 2019-2020 | General Assembly | Amended
Bill Title: Relates to the mandatory coverage of hearing aids by insurers and other organizations.
Spectrum: Slight Partisan Bill (Democrat 2-1)
Status: (Introduced - Dead) 2020-01-08 - referred to insurance [A02325 Detail]
Download: New_York-2019-A02325-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 2325--A 2019-2020 Regular Sessions IN ASSEMBLY January 22, 2019 ___________ Introduced by M. of A. SOLAGES, D'URSO, RA -- read once and referred to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee 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 Assem- bly, do enact as follows: 1 Section 1. Subsection (i) of section 3216 of the insurance law is 2 amended by adding a new paragraph 36 to read as follows: 3 (36) (A) As used in this paragraph, "hearing aid" shall mean a non- 4 disposable device that is of a design and circuitry to optimize audition 5 and listening skills in the environment commonly experienced by chil- 6 dren. 7 (B) This paragraph shall apply to the following entities: 8 (i) Insurers and nonprofit health service plans, including the office 9 of group benefits, that provide hospital, medical, or surgical benefits 10 to individuals or groups on an expense-incurred basis under health 11 insurance policies or contracts that are issued or delivered in this 12 state. 13 (ii) Managed care organizations as defined and licensed by state law 14 that provide hospital, medical or surgical benefits to individuals or 15 groups under contracts that are issued or delivered in this state. 16 (C) An entity subject to this paragraph shall provide coverage for 17 hearing aids for patients who are covered under a policy or contract of 18 insurance if the hearing aids are fitted and dispensed by a licensed 19 audiologist certified by the American Speech-Language-Hearing Associ- 20 ation following medical clearance by a physician licensed to practice 21 medicine and an audiological evaluation medically appropriate to the age 22 of the child, provided: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD05146-02-9A. 2325--A 2 1 (i) an entity subject to this paragraph may limit the benefit payable 2 under this paragraph to three thousand dollars per hearing aid for each 3 hearing-impaired ear every twenty-four months. 4 (ii) an insured or enrolled individual may choose a hearing aid that 5 is priced higher than the benefit payable under this paragraph and may 6 pay the difference between the price of the hearing aid and the benefit 7 payable under this paragraph without financial or contractual penalty to 8 the provider of the hearing aid. 9 (iii) in the case of a health insurer or managed care organization 10 that administers benefits according to contracts with health care 11 providers, hearing aids covered pursuant to this paragraph shall be 12 obtained from health care providers contracted with the health insurer 13 or managed care organization. Such providers shall be subject to the 14 same contracting and credentialing requirements that apply to other 15 contracted health care providers. 16 (D) This paragraph does not prohibit an entity subject to the 17 provisions of this paragraph from providing coverage that is greater or 18 more favorable to an insured or enrolled individual than the coverage 19 required under this paragraph. 20 (E) The provisions of this paragraph shall apply to any new policy, 21 contract, program, or plan issued by an entity subject to the provisions 22 of this paragraph on or after January first, two thousand twenty-one. 23 Any such policy, contract, program or plan in effect prior to January 24 first, two thousand twenty-one shall convert to the provisions of this 25 paragraph on or before the renewal date thereof but in no event later 26 than January first, two thousand twenty-one. Any policy affected by the 27 provisions of this paragraph shall apply to an insured or participant 28 under such policy, contract, program, or plan whether or not the hearing 29 impairment is a pre-existing condition of the insured or participant. 30 § 2. Section 3221 of the insurance law is amended by adding a new 31 subsection (u) to read as follows: 32 (u) (1) As used in this subsection, "hearing aid" shall mean a non- 33 disposable device that is of a design and circuitry to optimize audition 34 and listening skills in the environment commonly experienced by chil- 35 dren. 36 (2) This subsection shall apply to the following entities: 37 (A) Insurers and nonprofit health service plans, including the office 38 of group benefits, that provide hospital, medical, or surgical benefits 39 to individuals or groups on an expense-incurred basis under health 40 insurance policies or contracts that are issued or delivered in this 41 state. 42 (B) Managed care organizations as defined and licensed by state law 43 that provide hospital, medical or surgical benefits to individuals or 44 groups under contracts that are issued or delivered in this state. 45 (3) An entity subject to this subsection shall provide coverage for 46 hearing aids for patients who are covered under a policy or contract of 47 insurance if the hearing aids are fitted and dispensed by a licensed 48 audiologist certified by the American Speech-Language-Hearing Associ- 49 ation following medical clearance by a physician licensed to practice 50 medicine and an audiological evaluation medically appropriate to the age 51 of the child, provided: 52 (A) An entity subject to this subsection may limit the benefit payable 53 under this subsection to three thousand dollars per hearing aid for each 54 hearing-impaired ear every twenty-four months. 55 (B) An insured or enrolled individual may choose a hearing aid that is 56 priced higher than the benefit payable under this subsection and may payA. 2325--A 3 1 the difference between the price of the hearing aid and the benefit 2 payably under this subsection without financial or contractual penalty 3 to the provider of the hearing aid. 4 (C) In the case of a health insurer or managed care organization that 5 administers benefits according to contracts with health care providers, 6 hearing aids covered pursuant to this subsection shall be obtained from 7 health care providers contracted with the health insurer or managed 8 care organization. Such providers shall be subject to the same contract- 9 ing and credentialing requirements that apply to other contracted health 10 care providers. 11 (4) This subsection does not prohibit an entity subject to the 12 provisions of this subsection from providing coverage that is greater or 13 more favorable to an insured or enrolled individual than the coverage 14 required under this subsection. 15 (5) The provisions of this subsection shall apply to any new policy, 16 contract, program, or plan issued by an entity subject to the provisions 17 of this subsection on or after January first, two thousand twenty-one. 18 Any such policy, contract, program or plan in effect prior to January 19 first, two thousand twenty-one shall convert to the provisions of this 20 subsection on or before the renewal date thereof but in no event later 21 than January first, two thousand twenty-one. Any policy affected by the 22 provisions of this subsection shall apply to an insured or participant 23 under such policy, contract, program, or plan whether or not the hearing 24 impairment is a pre-existing condition of the insured or participant. 25 § 3. Section 4303 of the insurance law is amended by adding a new 26 subsection (ss) to read as follows: 27 (ss)(1) As used in this subsection, "hearing aid" shall mean a non- 28 disposable device that is of a design and circuitry to optimize audition 29 and listening skills in the environment commonly experienced by chil- 30 dren. 31 (2) This subsection shall apply to the following entities: 32 (A) Insurers and nonprofit health service plans, including the office 33 of group benefits, that provide hospital, medical, or surgical benefits 34 to individuals or groups on an expense-incurred basis under health 35 insurance policies or contracts that are issued or delivered in this 36 state. 37 (B) Managed care organizations as defined and licensed by state law 38 that provide hospital, medical or surgical benefits to individuals or 39 groups under contracts that are issued or delivered in this state. 40 (3) An entity subject to this subsection shall provide coverage for 41 hearing aids for patients who are covered under a policy or contract of 42 insurance if the hearing aids are fitted and dispensed by a licensed 43 audiologist certified by the American Speech-Language-Hearing Associ- 44 ation following medical clearance by a physician licensed to practice 45 medicine and an audiological evaluation medically appropriate to the age 46 of the child, provided: 47 (A) An entity subject to this subsection may limit the benefit payable 48 under this subsection to three thousand dollars per hearing aid for each 49 hearing-impaired ear every twenty-four months. 50 (B) An insured or enrolled individual may choose a hearing aid that is 51 priced higher then the benefit payable under his subsection and may pay 52 the difference between the price of the hearing aid and the benefit 53 payable under this subsection without financial or contractual penalty 54 to the provider of the hearing aid. 55 (C) In the case of the health insurer or managed care organization 56 that administers benefits according to contracts with health careA. 2325--A 4 1 providers, hearing aids covered pursuant to this subsection shall be 2 obtained from health care providers contracted with the health insurer 3 or managed care organization. Such providers shall be subject to the 4 same contracting and credentialing requirements that apply to other 5 contracted health care providers. 6 (4) This subsection does not prohibit an entity subject to the 7 provisions of this subsection from providing coverage that is greater or 8 more favorable to an insured or enrolled individual than the coverage 9 required under this subsection. 10 (5) The provisions of this subsection shall apply to any new policy, 11 contract, program, or plan issued by an entity subject to the provisions 12 of this subsection on or after January first, two thousand twenty-one. 13 Any such policy, contract, program or plan in effect prior to January 14 first, two thousand twenty-one shall convert to the provisions of this 15 subsection on or before the renewal date thereof but in no event later 16 than January first, two thousand twenty-one. Any policy affected by the 17 provision of this subsection shall apply to an insured or participant 18 under such policy, contract, program, or plan whether or not the hearing 19 impairment is a pre-existing condition of the insured or participant. 20 § 4. This act shall take effect on the ninetieth day after it shall 21 have become a law. Effective immediately, the addition, amendment and/or 22 repeal of any rule or regulation necessary for the implementation of 23 this act on its effective date are authorized to be made and completed 24 on or before such date.
