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Legislation Document
SPONSOR:
Sen. Sturgeon & Rep. Wilson-Anton
Sens. Cruce, Huxtable, Seigfried, Walsh; Reps. Burns, Griffith, Morrison, Neal, Romer
DELAWARE STATE SENATE
153rd GENERAL ASSEMBLY
SENATE SUBSTITUTE NO. 2
FOR
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.
“Cochlear
implant”
includes
an
external
sound
processor
that
sits
behind
the
ear or on the
scalp.
(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 in this State on or after January 1, 2009,
renewed, extended, or modified in this State
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.
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 cost-sharing amount that a covered individual is required to pay for
benefits provided
under
paragraph
(b)(1)a.
of
this
section
,
including
deductible
payments
and
cost-sharing amounts
charged
once
a
deductible
is
met,
may not
exceed 5% of the total cost of the covered benefits
.
(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)
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
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 in this section shall preclude the
aid.
(d)(1) Nothing in this section prevents an
insurer from conducting managed care, medical necessity, or utilization
review or prevent the operation of such policy provisions as deductibles,
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
limitations,
limitation,
coordination of
benefits or provisions
benefits, or 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;
supplements.
(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.
“Cochlear
implant”
includes
an
external
sound
processor
that
sits
behind
the
ear or on the
scalp.
(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 in this State on or after January 1, 2009,
renewed, extended, or modified in this State
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.
for
all
of the
following
for
individuals
younger
than
26
years
old
and
covered
as
a
dependent
by
the
policyholder:
(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 cost-sharing amount that a covered individual is required to pay for benefits provided under paragraph (b)(1)a. of this section, including deductible payments and cost-sharing amounts charged once a deductible is met, may not exceed 5% of the total cost of the covered benefits.
(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)
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
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 in this section shall preclude the
aid.
(d)(1) Nothing in this section prevents an
insurer from conducting managed care, medical necessity, or utilization
review or prevent the operation of such policy provisions as deductibles,
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
limitations,
limitation,
coordination of
benefits or provisions
benefits, or 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.
“Cochlear
implant”
includes
an
external
sound
processor
that
sits
behind
the
ear or on the
scalp.
(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
for
individuals
younger
than
26
years
old
and
covered
as
a
dependent
by
the
policyholder:
(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 cost-sharing amount that a covered individual is required to pay for benefits provided under paragraph (b)(1)a. of this section, including deductible payments and cost-sharing amounts charged once a deductible is met, may not exceed 5% of the total cost of the covered benefits.
(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
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
is
known as
the
T.
Hollis
Jennings
Act.
Section
5.
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 currently require insurers to cover the costs of cochlear implants.
This Act is a second substitute for Senate Bill No. 269 and differs from the first substitute Senate Bill No. 269 by changing the cost-sharing limitation to require insurers to cover at least 95%, instead 100%, of the cost of benefits for hearing aid and earmold benefits provided under § 3357(b)(1)a., § 3571A(b)(1)a., and § 5224(b)(1)a. of this Act.
Like the first substitute to Senate Bill No. 269, this Act differs from Senate Bill No. 269 in all of the following ways:
1) Includes external sound processors in the definition of a cochlear implant.
2) Clarifies that, for group and blanket health policies and the state employee health plan, the required coverage of hearing-aid related parts and services is limited to individuals younger than 26 years old and covered as a dependent by the policyholder.
3) Names this Act in honor of T. Hollis Jennings who is a testament to the success of state-mandated hearing aid coverage and early intervention. Hollis got hearing aids when she was an infant. Her language developed typically, with no need for speech therapy. She now exceeds grade-level benchmarks in math and ELA. She’s also a phenomenal singer.
4) Makes technical changes to strike through and underline format to make it easier to see changes and to correct grammar.
Like Senate Bill No. 269 and the first substitute for Senate Bill No. 269, 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:
1) 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.
2) Medically necessary hearing aid-related parts, attachments, or accessories.
3) 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.
For individual health insurance policies, the coverage required under this Act applies to all covered individuals, regardless of age, 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 and 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