NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A6314A
SPONSOR: Wieder TITLE OF BILL:
An act to amend the insurance law, in relation to ensuring continued
access to backup devices for patients with cochlear implants
PURPOSE OR GENERAL IDEA OF BILL:
To require insurance coverage for backup cochlear implant devices to
ensure uninterrupted access for patients during device upgrades or
replacements.
SUMMARY OF PROVISIONS:
This bill amends Sections 3221 and 4303 of the Insurance Law to mandate
that all large group health insurance policies providing medical or
major medical coverage must include:
1. Coverage for Cochlear Implants and Backup Devices:
*Insurance plans must cover cochlear implants and provide a backup
device when prescribed by a licensed healthcare practitioner.
2. Provision of Backup Devices During Upgrades/Replacements:
*Patients receiving an upgrade or replacement cochlear implant must be
provided with a corresponding backup device, ensuring continuous hearing
capability.
3. Definitions:
*Cochlear Implant: A surgically implanted medical device that provides
hearing to individuals with severe to profound sensorineural hearing
loss.
*Backup Cochlear Implant Device: An additional set of external compo-
nents of the cochlear implant, including a processor, if the primary
device fails or requires maintenance.
4. Severability:
*If any part of this act is deemed invalid, the remaining sections will
continue in effect.
5. Effective Date:
* This act shall take effect on January 1, 2027 and will apply to all
relevant insurance policies issued, renewed, or modified on or after
that date.
JUSTIFICATION:
Cochlear implants are life-changing devices for individuals with severe
hearing loss, restoring the ability to hear and significantly improving
quality of life. However, current insurance practices often provide
backup devices only at the time of initial implantation, leaving
patients vulnerable during upgrades or replacements that typically occur
every 3-5 years.
Without a functioning device, patients-especially children-may experi-
ence periods of complete hearing loss, leading to developmental
setbacks, communication challenges, and safety concerns. This bill
addresses a critical gap in insurance coverage, ensuring patients have
access to backup devices throughout the lifespan of their cochlear
implant, thereby preventing interruptions in hearing.
By guaranteeing continuous access to these essential devices, this
legislation promotes better health outcomes, supports social inte-
gration, and protects the rights and well-being of individuals relying
on cochlear implants.
PRIOR LEGISLATIVE HISTORY: None
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
Minimal. While insurance providers may incur additional costs for cover-
ing backup devices, the overall impact is expected to be limited. The
potential long-term savings from avoiding complications related to
interrupted hearing may offset initial expenses.
EFFECTIVE DATE:
This act shall take effect on January 1, 2027 and will apply to all
policies and contracts issued, renewed, modified, altered, or amended on
or after such date.
STATE OF NEW YORK
________________________________________________________________________
6314--A
2025-2026 Regular Sessions
IN ASSEMBLY
March 4, 2025
___________
Introduced by M. of A. WIEDER, WOERNER, PAULIN, MAGNARELLI, EICHENSTEIN,
TAYLOR, TORRES, KAY, WEPRIN, WRIGHT, BENEDETTO, RAJKUMAR, LAVINE,
HEVESI, WILLIAMS, ROZIC, BURDICK, R. CARROLL, SAYEGH, COLTON, ZACCARO,
YEGER, BORES, LEVENBERG, KASSAY, LUNSFORD, P. CARROLL, EACHUS,
E. BROWN -- 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 ensuring continued
access to backup devices for patients with cochlear implants
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Legislative intent. The legislature finds that cochlear
2 implants are critical for patients with hearing loss to maintain the
3 ability to hear. These devices, which are often life-changing, allow
4 individuals to improve their quality of life, integrate fully into their
5 communities, and perform daily activities. It is essential that individ-
6 uals who rely on cochlear implants have continuous access to the neces-
7 sary backup equipment to ensure uninterrupted use, including during
8 device upgrades and replacements. Currently, backup devices are provided
9 only with the initial implantation, but are not made available to
10 patients upon the upgrade or replacement of the implant after 3-5 years.
11 This bill seeks to address this gap in coverage and ensure that all
12 patients requiring cochlear implants have a backup device available
13 throughout the duration of their treatment.
14 § 2. Subsection (k) of section 3221 of the insurance law is amended
15 by adding a new paragraph 24 to read as follows:
16 (24) (A) Every large group policy which provides medical, major
17 medical, or similar comprehensive-type coverage shall provide the cover-
18 age for a backup cochlear implant device when prescribed by a health
19 care practitioner licensed, certified, or authorized under title eight
20 of the education law, and acting within their lawful scope of practice.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD10291-02-5
A. 6314--A 2
1 (B) Coverage of the backup device shall be provided as long as the
2 insured is actively using the cochlear implant, and for the duration of
3 the insured's need for the device, including any necessary upgrades.
4 (C) The coverage provided under this paragraph may be subject to annu-
5 al deductibles, copayments and coinsurance as may be deemed appropriate
6 by the superintendent and shall be consistent with those imposed on
7 other similar benefits under the policy.
8 (D) For the purposes of this paragraph:
9 (i) "cochlear implant" means a medical device surgically implanted to
10 provide hearing to individuals with severe to profound sensorineural
11 hearing loss; and
12 (ii) "backup cochlear implant device" means an additional set of
13 external components of the cochlear implant, including a processor, in
14 the event that the primary device fails or requires maintenance.
15 § 3. Section 4303 of the insurance law is amended by adding a new
16 subsection (ww) to read as follows:
17 (ww) (1) Every large group policy which provides medical, major
18 medical, or similar comprehensive-type coverage shall provide the cover-
19 age for a backup cochlear implant device when prescribed by a health
20 care practitioner licensed, certified, or authorized under title eight
21 of the education law, and acting within their lawful scope of practice.
22 (2) Coverage of the backup device shall be provided as long as the
23 insured is actively using the cochlear implant, and for the duration of
24 the insured's need for the device, including any necessary upgrades.
25 (3) The coverage required under this subsection shall be subject to
26 annual deductibles, copayments and coinsurance as may be deemed appro-
27 priate by the superintendent and shall be consistent with those imposed
28 on other similar benefits under the contract.
29 (4) For the purposes of this subsection:
30 (A) "cochlear implant" means a medical device surgically implanted to
31 provide hearing to individuals with severe to profound sensorineural
32 hearing loss; and
33 (B) "backup cochlear implant device" means an additional set of
34 external components of the cochlear implant, including a processor, in
35 the event that the primary device fails or requires maintenance.
36 § 4. Severability. If any clause, sentence, paragraph, subdivision,
37 section or part of this act shall be adjudged by any court of competent
38 jurisdiction to be invalid, such judgment shall not affect, impair, or
39 invalidate the remainder thereof, but shall be confined in its operation
40 to the clause, sentence, paragraph, subdivision, section or part thereof
41 directly involved in the controversy in which such judgment shall have
42 been rendered. It is hereby declared to be the intent of the legislature
43 that this act would have been enacted even if such invalid provisions
44 had not been included herein.
45 § 5. This act shall take effect January 1, 2027 and shall apply to all
46 policies and contracts issued, renewed, modified, altered or amended on
47 or after such date.
