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Legislation Document
SPONSOR:
Sen. Sturgeon & Rep. Wilson-Anton
Reps. Burns, Morrison, Neal, Romer
DELAWARE STATE SENATE
153rd GENERAL ASSEMBLY
SENATE BILL NO. 269
AN ACT AMEND TITLE 18 AND TITLE 29 OF THE DELAWARE CODE RELATING TO HEARING AID COVERAGE.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:
Section 1. Amend § 3357, Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3357. Hearing aid coverage.
(a) For purposes of this
section, the term “hearing aid”
section:
(1) “Bone-anchored hearing aid” means a hearing aid with a bone-conduction receiver that transmits sound through the bones to the inner ear.
“Bone-anchored hearing aid” includes all of the following:
a. A surgically implanted device.
b. A nonsurgical device that is worn on a headband or attached to the skin with adhesive.
(2) “Cochlear implant” means a device that is surgically implanted in the inner ear to treat an individual with significant hearing impairment or deafness.
(3) “Hearing aid”
means any
nonexperimental, wearable instrument or device designed for the ear and
medically necessary nonexperimental instrument, device, or assistive technology
offered for the purpose of aiding or compensating for impaired human
hearing, but excluding batteries, cords, and other assistive listening devices such as FM systems.
hearing. “Hearing aid” includes all of the following:
a. A hearing aid with an earmold.
b. A hearing aid with a slim tube.
c. A receiver-in-ear hearing aid.
d. A bone-anchored hearing aid.
e.
A cochlear implant.
(4) “Related services”
include the services of a hearing care professional relating to prescribing, fitting, implanting, or dispensing a hearing aid.
(b)
Every
All
individual health insurance
contract, including each policy or contract issued by a health service corporation, which is
policies, contracts, or certificates that are
delivered, issued for delivery,
or renewed
renewed, extended, or modified
in this State
on or after January 1, 2009,
shall provide coverage
of up to $1000 per individual hearing aid, per ear, every 3 years, for children less than 24 years of age, covered as a dependent by the policy holder.
(c) The insured may choose a hearing aid exceeding $1,000 and pay the difference in cost above the amount of coverage required by this section.
Reimbursement shall be provided according to the respective principles and policies of the insurer.
The
for all of the following
:
(1)a. One hearing aid for each ear at least every 3 years or, prior to the expiration of the 3-year period, whenever a hearing care professional determines a new hearing aid is medically necessary for 1 or both ears. For a hearing aid with an earmold, at least 1 earmold for each ear at least annually or, prior to the expiration of the 1-year period, whenever a hearing care professional determines a new earmold is medically necessary for 1 or both ears.
b. The coverage required under paragraph (b)(1)a. of this section must be provided at no cost to a covered individual, including deductible payments and cost-sharing amounts charged once a deductible is met.
(2) Medically necessary hearing aid-
related parts, attachments, or accessories.
(3)a. Medically necessary related services.
b. The coverage required under paragraph (b)(3)a. of this section must include medically necessary related services provided by a hearing care professional who specializes in providing care to pediatric patients.
(c) An
insurer may require
the policyholder
a covered individual
to provide a prescription or
show proof
through
other suitable documentation
of
to prove
the need for a hearing
aid and nothing contained
aid.
(d)(1) Nothing
in this section
shall preclude the
prevents an
insurer from conducting managed care, medical necessity, or utilization
review or prevent
review.
(2) Except as otherwise provided in subsection (b) of this section, nothing in this section prevents
the operation of
such
a
policy
provisions
provision such
as
deductibles,
a deductible,
coinsurance, allowable charge
limitations,
limitation,
coordination of
benefits
benefits,
or
provisions
a provision
restricting coverage to services by licensed,
certified
certified,
or carrier-approved providers or facilities.
(e)(1) The cost-sharing limitation under paragraph (b)(1)b. of this section does not apply to a catastrophic health plan to the extent this cost-sharing limitation would cause the plan to fail to be treated as a catastrophic plan under § 1302(e) of the Patient Protection and Affordable Care Act, 42 U.S.C. § 18022(e).
(2)a. The cost-sharing limitation under paragraph (b)(1)b. of this section does not apply to a high deductible health plan to the extent this cost-sharing limitation would cause the plan to fail to be treated as a high deductible health plan under § 223(c)(2) of the Internal Revenue Code [26 U.S.C. § 223(c)(2)].
b. If the cost-sharing limitation under paragraph (b)(1)b. of this section would result in an enrollee becoming ineligible for a health savings account under federal law, this cost-sharing limitation only applies to a qualified high deductible health plan after the enrollee’s deductible has been met.
(d)
(f)
This section does not apply to
insurance coverage providing benefits for:
any of the following limited benefit health insurance policies:
(1) Hospital confinement
indemnity;
indemnity.
(2) Disability
income;
income.
(3) Accident
only;
only.
(4) Long-term
care;
care.
(5) Medicare
supplement;
supplement.
(6) Limited benefit
health;
health.
(7) Specified
diseased indemnity;
disease indemnity.
(8) Sickness or bodily injury or death by
accident, or both; and
accident.
(9) Other limited benefit policies.
Section 2. Amend § 3571A, Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3571A. Hearing aid coverage.
(a) For purposes of this
section, the term “hearing aid”
section:
(1) “Bone-anchored hearing aid” means a hearing aid with a bone-conduction receiver that transmits sound through the bones to the inner ear. “Bone-anchored hearing aid” includes all of the following:
a. A surgically implanted device.
b. A nonsurgical device that is worn on a headband or attached to the skin with adhesive.
(2) “Cochlear implant” means a device that is surgically implanted in the inner ear to treat an individual with significant hearing impairment or deafness.
(3) “Hearing aid”
means any
nonexperimental, wearable instrument or device designed for the ear and
medically necessary nonexperimental instrument, device, or assistive technology
offered for the purpose of aiding or compensating for impaired human
hearing, but excluding batteries, cords, and other assistive listening devices such as FM systems.
hearing. “Hearing aid” includes all of the following:
a. A hearing aid with an earmold.
b. A hearing aid with a slim tube.
c. A receiver-in-ear hearing aid.
d. A bone-anchored hearing aid.
e. A cochlear implant.
(4) “Related services”
include the services of a hearing care professional relating to prescribing, fitting, implanting, or dispensing a hearing aid.
(b)
Every
All
group and blanket health insurance
contract, including each policy or contract issued by a health service corporation, which is
policies, contracts, or certificates that are
delivered, issued for delivery,
or renewed
renewed, extended, or modified
in this State
on or after January 1, 2009,
shall provide coverage
of up to $1000 per individual hearing aid, per ear, every 3 years, for children less than 24 years of age, covered as a dependent by the policy holder.
(c) The insured may choose a hearing aid exceeding $1,000 and pay the difference in cost above the amount of coverage required by this section. Reimbursement shall be provided according to the respective principles and policies of the insurer. The
for all of the following:
(1)a.
For individuals younger than 26 years old and covered as a dependent by the policyholder, 1
hearing aid for each ear at least every 3 years or, prior to the expiration of the 3-year period, whenever a hearing care professional determines a new hearing aid is medically necessary for 1 or both ears. For a hearing aid with an earmold, at least 1 earmold for each ear at least annually or, prior to the expiration of the 1-year period, whenever a hearing care professional determines a new earmold is medically necessary for 1 or both ears.
b. The coverage required under paragraph (b)(1)a. of this section must be provided at no cost to a covered individual, including deductible payments and cost-sharing amounts charged once a deductible is met.
(2) Medically necessary hearing aid-
related parts, attachments, or accessories.
(3)a. Medically necessary related services.
b. The coverage required under paragraph (b)(3)a. of this section must include medically necessary related services provided by a hearing care professional who specializes in providing care to pediatric patients.
(c)
An
insurer may require
the policyholder
a covered individual
to provide a prescription or
show proof through
other suitable documentation
of
to prove
the need for a hearing
aid and nothing contained
aid.
(d)(1) Nothing
in this section
shall preclude the
prevents an
insurer from conducting managed care, medical necessity, or utilization
review or prevent
review.
(2) Except as otherwise provided in subsection (b) of this section, nothing in this section prevents
the operation of
such
a
policy
provision
provision such
as
deductibles,
a deductible,
coinsurance, allowable charge
limitations,
limitation,
coordination of
benefits
benefits,
or
provisions
a provision
restricting coverage to services by licensed,
certified
certified,
or carrier-approved providers or facilities.
(e)(1) The cost-sharing limitation under paragraph (b)(1)b. of this section does not apply to a high deductible health plan to the extent this cost-sharing limitation would cause the plan to fail to be treated as a high deductible health plan under § 223(c)(2) of the Internal Revenue Code [26 U.S.C. § 223(c)(2)].
(2) If the cost-sharing limitation under paragraph (b)(1)b. of this section would result in an enrollee becoming ineligible for a health savings account under federal law, this cost-sharing limitation only applies to a qualified high deductible health plan after the enrollee’s deductible has been met.
(d)
(f)
This section does not apply to
insurance coverage providing benefits for:
any of the following limited benefit health insurance policies:
(1) Hospital confinement
indemnity;
indemnity.
(2) Disability
income;
income.
(3) Accident
only;
only.
(4) Long-term
care;
care.
(5) Medicare
supplement;
supplement.
(6) Limited benefit
health;
health.
(7) Specified
diseased indemnity;
disease indemnity.
(8) Sickness or bodily injury or death by
accident or both; and
accident.
(9) Other limited benefit policies.
Section 3. Amend Chapter 52, Title 29 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 5224. Hearing aid coverage.
(a) For purposes of this section:
(1) “Bone-anchored hearing aid” means a hearing aid with a bone-conduction receiver that transmits sound through the bones to the inner ear. “Bone-anchored hearing aid” includes all of the following:
a. A surgically implanted device.
b. A nonsurgical device that is worn on a headband or attached to the skin with adhesive.
(2) “Cochlear implant” means a device that is surgically implanted in the inner ear to treat an individual with significant hearing impairment or deafness.
(3) “Hearing aid” means any medically necessary nonexperimental instrument, device, or assistive technology offered for the purpose of aiding or compensating for impaired human hearing. “Hearing aid” includes all of the following:
a. A hearing aid with an earmold.
b. A hearing aid with a slim tube.
c. A receiver-in-ear hearing aid.
d. A bone-anchored hearing aid.
e. A cochlear implant.
(4) “Related services”
include the services of a hearing care professional relating to prescribing, fitting, implanting, or dispensing a hearing aid.
(b) The plan shall provide coverage for all of the following:
(1)a. For individuals younger than 26 years old and covered as a dependent by the policyholder, 1
hearing aid for each ear at least every 3 years or, prior to the expiration of the 3-year period, whenever a hearing care professional determines a new hearing aid is medically necessary for 1 or both ears. For a hearing aid with an earmold, at least 1 earmold for each ear at least annually or, prior to the expiration of the 1-year period, whenever a hearing care professional determines a new earmold is medically necessary for 1 or both ears.
b. The coverage required under paragraph (b)(1)a. of this section must be provided at no cost to a covered individual, including deductible payments and cost-sharing amounts charged once a deductible is met.
(2) Medically necessary hearing aid-
related parts, attachments, or accessories.
(3)a. Medically necessary related services.
b. The coverage required under paragraph (b)(3)a. of this section must include medically necessary related services provided by a hearing care professional who specializes in providing care to pediatric patients.
(c)
A carrier plan may require a covered individual to provide a prescription or other suitable documentation to prove the need for a hearing aid.
(d)(1) Nothing in this section prevents a carrier from conducting managed care, medical necessity, or utilization review.
(2) Except as otherwise provided in subsection (b) of this section, nothing in this section prevents the operation of a policy provision such as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by licensed, certified, or carrier-approved providers or facilities.
Section 4. This Act applies to all policies, contracts, or certificates issued, renewed, modified, altered, amended,
or reissued after December 31, 2027.
SYNOPSIS
Early access to language is essential to child development. Children identified as Deaf or hard of hearing rely on hearing aids for language development. Language development leads to success in school. Medicaid coverage of hearing aids for children younger than 21 years old applies only to children who qualify for Medicaid. Delaware currently requires private insurers to provide minimum coverage of $1,000 for each hearing aid for individuals younger than 24 years old, covered as a dependent by the policyholder. The cost of hearing aids can vary widely but can cost from $3,000 to $5,000 out-of-pocket. This can be too expensive for families, even with the current $1,000 coverage requirement. The cost of a cochlear implant can range from $30,000 to $100,000, depending on the necessary device, surgery, and rehabilitation. Delaware does not require insurers to cover the costs of cochlear implants.
This Act requires individual health insurance policies under Chapter 33 of Title 18, group and blanket health insurance policies under Chapter 35 of Title 18, and the state employee health plan under Chapter 52 of Title 29 to cover all of the following:
• At no cost to the covered individual, at least 1 hearing aid for each ear at least every 3 years, or before the expiration of the 3-year period if a health care professional determines that a new hearing aid is medically necessary. For hearing aids with earmolds, insurers are required to cover at least 1 earmold for each ear at least annually, or sooner if new earmolds are medically necessary. The cost-sharing limitation applies only to coverage of hearing aids. The types of hearing aid covered includes a hearing aid with an earmold, a hearing aid with slim tubing, a receiver-in-ear hearing aid, a bone-anchored hearing aid, and a cochlear implant.
• Medically necessary hearing aid-related parts, attachments, or accessories.
• Medically necessary related services related to prescribing, fitting, implanting, or dispensing hearing aids. Coverage must include medically necessary related services provided by a hearing care professional who specializes in providing care to pediatric patients.
The required coverage for hearing aids applies to all covered individuals, regardless of age, for individual health insurance policies because federal law prohibits states from limiting coverage for an essential health benefit based on an individual’s age, unless there is a clinical reason. For group and blanket health insurance policies and the state employee health plan, the required coverage applies only to individuals younger than 26 years old, covered as a dependent by the policyholder.
This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual and reorganizes paragraphs for clarity.
This Act applies to all policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2027.
Author: Senator Sturgeon