Bill Text: NY S05495 | 2019-2020 | General Assembly | Introduced
Bill Title: Relates to the mandatory coverage of hearing aids by insurers and other organizations.
Spectrum: Partisan Bill (Democrat 5-0)
Status: (Introduced - Dead) 2020-01-08 - REFERRED TO INSURANCE [S05495 Detail]
Download: New_York-2019-S05495-Introduced.html
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 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: 23 (i) an entity subject to this paragraph may limit the benefit payable 24 under this paragraph to three thousand dollars per hearing aid for each 25 hearing-impaired ear every twenty-four months. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD05146-03-9S. 5495 2 1 (ii) an insured or enrolled individual may choose a hearing aid that 2 is priced higher than the benefit payable under this paragraph and may 3 pay the difference between the price of the hearing aid and the benefit 4 payable under this paragraph without financial or contractual penalty to 5 the provider of the hearing aid. 6 (iii) in the case of a health insurer or managed care organization 7 that administers benefits according to contracts with health care 8 providers, hearing aids covered pursuant to this paragraph shall be 9 obtained from health care providers contracted with the health insurer 10 or managed care organization. Such providers shall be subject to the 11 same contracting and credentialing requirements that apply to other 12 contracted health care providers. 13 (D) This paragraph does not prohibit an entity subject to the 14 provisions of this paragraph from providing coverage that is greater or 15 more favorable to an insured or enrolled individual than the coverage 16 required under this paragraph. 17 (E) The provisions of this paragraph shall apply to any new policy, 18 contract, program, or plan issued by an entity subject to the provisions 19 of this paragraph on or after January first, two thousand twenty-one. 20 Any such policy, contract, program or plan in effect prior to January 21 first, two thousand twenty-one shall convert to the provisions of this 22 paragraph on or before the renewal date thereof but in no event later 23 than January first, two thousand twenty-one. Any policy affected by the 24 provisions of this paragraph shall apply to an insured or participant 25 under such policy, contract, program, or plan whether or not the hearing 26 impairment is a pre-existing condition of the insured or participant. 27 § 2. Section 3221 of the insurance law is amended by adding a new 28 subsection (u) to read as follows: 29 (u) (1) As used in this subsection, "hearing aid" shall mean a non- 30 disposable device that is of a design and circuitry to optimize audition 31 and listening skills in the environment commonly experienced by chil- 32 dren. 33 (2) This subsection shall apply to the following entities: 34 (A) Insurers and nonprofit health service plans, including the office 35 of group benefits, that provide hospital, medical, or surgical benefits 36 to individuals or groups on an expense-incurred basis under health 37 insurance policies or contracts that are issued or delivered in this 38 state. 39 (B) Managed care organizations as defined and licensed by state law 40 that provide hospital, medical or surgical benefits to individuals or 41 groups under contracts that are issued or delivered in this state. 42 (3) An entity subject to this subsection shall provide coverage for 43 hearing aids for patients who are covered under a policy or contract of 44 insurance if the hearing aids are fitted and dispensed by a licensed 45 audiologist certified by the American Speech-Language-Hearing Associ- 46 ation following medical clearance by a physician licensed to practice 47 medicine and an audiological evaluation medically appropriate to the age 48 of the child, provided: 49 (A) An entity subject to this subsection may limit the benefit payable 50 under this subsection to three thousand dollars per hearing aid for each 51 hearing-impaired ear every twenty-four months. 52 (B) An insured or enrolled individual may choose a hearing aid that is 53 priced higher than the benefit payable under this subsection and may pay 54 the difference between the price of the hearing aid and the benefit 55 payably under this subsection without financial or contractual penalty 56 to the provider of the hearing aid.S. 5495 3 1 (C) In the case of a health insurer or managed care organization that 2 administers benefits according to contracts with health care providers, 3 hearing aids covered pursuant to this subsection shall be obtained from 4 health care providers contracted with the health insurer or managed 5 care organization. Such providers shall be subject to the same contract- 6 ing and credentialing requirements that apply to other contracted health 7 care providers. 8 (4) This subsection does not prohibit an entity subject to the 9 provisions of this subsection from providing coverage that is greater or 10 more favorable to an insured or enrolled individual than the coverage 11 required under this subsection. 12 (5) The provisions of this subsection shall apply to any new policy, 13 contract, program, or plan issued by an entity subject to the provisions 14 of this subsection on or after January first, two thousand twenty-one. 15 Any such policy, contract, program or plan in effect prior to January 16 first, two thousand twenty-one shall convert to the provisions of this 17 subsection on or before the renewal date thereof but in no event later 18 than January first, two thousand twenty-one. Any policy affected by the 19 provisions of this subsection shall apply to an insured or participant 20 under such policy, contract, program, or plan whether or not the hearing 21 impairment is a pre-existing condition of the insured or participant. 22 § 3. Section 4303 of the insurance law is amended by adding a new 23 subsection (ss) to read as follows: 24 (ss)(1) As used in this subsection, "hearing aid" shall mean a non- 25 disposable device that is of a design and circuitry to optimize audition 26 and listening skills in the environment commonly experienced by chil- 27 dren. 28 (2) This subsection shall apply to the following entities: 29 (A) Insurers and nonprofit health service plans, including the office 30 of group benefits, that provide hospital, medical, or surgical benefits 31 to individuals or groups on an expense-incurred basis under health 32 insurance policies or contracts that are issued or delivered in this 33 state. 34 (B) Managed care organizations as defined and licensed by state law 35 that provide hospital, medical or surgical benefits to individuals or 36 groups under contracts that are issued or delivered in this state. 37 (3) An entity subject to this subsection shall provide coverage for 38 hearing aids for patients who are covered under a policy or contract of 39 insurance if the hearing aids are fitted and dispensed by a licensed 40 audiologist certified by the American Speech-Language-Hearing Associ- 41 ation following medical clearance by a physician licensed to practice 42 medicine and an audiological evaluation medically appropriate to the age 43 of the child, provided: 44 (A) An entity subject to this subsection may limit the benefit payable 45 under this subsection to three thousand dollars per hearing aid for each 46 hearing-impaired ear every twenty-four months. 47 (B) An insured or enrolled individual may choose a hearing aid that is 48 priced higher then the benefit payable under his subsection and may pay 49 the difference between the price of the hearing aid and the benefit 50 payable under this subsection without financial or contractual penalty 51 to the provider of the hearing aid. 52 (C) In the case of the health insurer or managed care organization 53 that administers benefits according to contracts with health care 54 providers, hearing aids covered pursuant to this subsection shall be 55 obtained from health care providers contracted with the health insurer 56 or managed care organization. Such providers shall be subject to theS. 5495 4 1 same contracting and credentialing requirements that apply to other 2 contracted health care providers. 3 (4) This subsection does not prohibit an entity subject to the 4 provisions of this subsection from providing coverage that is greater or 5 more favorable to an insured or enrolled individual than the coverage 6 required under this subsection. 7 (5) The provisions of this subsection shall apply to any new policy, 8 contract, program, or plan issued by an entity subject to the provisions 9 of this subsection on or after January first, two thousand twenty-one. 10 Any such policy, contract, program or plan in effect prior to January 11 first, two thousand twenty-one shall convert to the provisions of this 12 subsection on or before the renewal date thereof but in no event later 13 than January first, two thousand twenty-one. Any policy affected by the 14 provision of this subsection shall apply to an insured or participant 15 under such policy, contract, program, or plan whether or not the hearing 16 impairment is a pre-existing condition of the insured or participant. 17 § 4. This act shall take effect on the ninetieth day after it shall 18 have become a law. Effective immediately, the addition, amendment and/or 19 repeal of any rule or regulation necessary for the implementation of 20 this act on its effective date are authorized to be made and completed 21 on or before such date.
