Hearing devices-insurance coverage.

WORKING DRAFT
2012
STATE OF
WYOMING
12LSO-0172

SENATE FILE
NO.
SF0080

Hearing
devices
-insurance coverage.

Sponsored by:
Senator(s) Hastert and Martin and Representative(s) Blake, Craft, Harshman, Hunt, Jaggi, Reeder and Vranish

A BILL

for

AN ACT relating to
insurance; providing that health insurance policies and health maintenance organization subscriber contracts provide coverage for hearing aids
and cochlear implants
as specified; providing for coverage limits; providing for applicability of hearing
device
coverage; providing definitions;
and providing for an effective date.

Be It Enacted by the Legislature of the State of Wyoming:

Section 1.
W.S. 26
‑
20
‑
401 is created to read:

ARTICLE 4
HEARING
DEVICE
COVERAGE

26
‑
20
‑
401.

Required coverage for hearing
devices
.

(a)

All individual and group health insurance policies providing coverage on an expense incurred basis, individual and group service or indemnity type contracts issued by any insurer including any nonprofit corporation and individual and group service contracts issued by a health maintenance organization, which provide coverage shall also provide coverage for
hearing
devices
for
covered individuals
who have a hearing loss that has been verified by a physician licensed pursuant to title 33, chapter 26 of the Wyoming statutes and by an audiologist licensed pursuant to title 33, chapter 33 of the Wyoming statutes.
Hearing
device
coverage pursuant to this section shall be subject to the following:

(i)

This section shall apply to insured individuals
who
are under age twenty-five (25);

(i
i
)

Hearing
devices
shall be medically appropriate to meet the
hearing
needs of the
insured individual
according to accepted professional standards;

(i
i
i)

Coverage shall include
:

(A)

T
he full cost of one (1) hearing aid per hearing impaired ear, up to
two
thousand dollars ($
2
,
0
00.00) per ear, every three (3) years
or sooner if alterations to an existing hearing aid cannot meet the hearing needs of the
insured individual
and a new hearing aid will provide substantially improved hearing
;

(B)

If medically indicated, the reasonable and customary cost of cochlear implants.

(i
v
)

The insured may choose a high
er
priced hearing aid and may pay the difference in cost above the amount stated in paragraph (ii) of this subsection
without financial or contractual penalty to the insured or to the provider of the hearing aid
;

(v)

The insurer may require the insured to provide a prescription or show proof through other suitable documentation of the need for a hearing
device
.

(b)

Nothing in this section shall preclude the insurer from conducting managed care, medical necessity or utilization review as for other benefits under the policy, nor preclude the operation of other policy provisions such
as deductibles, coinsurance, coordination of benefits or provisions restricting coverage to services provided by insurer approved providers or facilities.
Any deductibles, coinsurance or copayments may be charged to the insured only to the same extent as for other durable medical equipment under the policy.
The lack of an insurer approved provider or facility for hearing devices shall not preclude coverage for hearing devices pursuant to this section.

(c)

For purposes of this section
:

(i)

"Cochlear implant" means a
surgically
implantable instrument that
provides a sense of sound to a person with a severe hearing impairment, and
includ
es
services necessary to select,
implant
and adjust the cochlear implant
;

(
i
i)

"H
earing aid" means any nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensa
ting for impaired human hearing. "Hearing aid" includes
earmolds and
necessary services to select, fit and adjust
the hearing aid
, but
exclud
es accessories such as
batteries,
cords and other assistive listening devices such as
radio or digital audio headphones;

(iii)

"Hearing device" means a hearing aid or a cochlear implant
.

(d)

Th
is
article
shall
apply to all insurance policies and subscriber contracts
described in
subsection
(a) of this section and
delivered or issued for delivery in this state after
July 1
,
2012.

Section 2.

This act is effective July 1, 2012.

(END)

1
SF0080