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A02325 Summary:

BILL NOA02325A
 
SAME ASSAME AS S05495
 
SPONSORSolages
 
COSPNSRD'Urso, Ra
 
MLTSPNSR
 
Amd 3216, 3221 & 4303, Ins L
 
Relates to the mandatory coverage of hearing aids by insurers and other organizations.
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A02325 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         2325--A
 
                               2019-2020 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 22, 2019
                                       ___________
 
        Introduced  by M. of A. SOLAGES, D'URSO, RA -- 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 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:
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05146-02-9

        A. 2325--A                          2
 
     1    (i) an entity subject to this paragraph may limit the benefit  payable
     2  under  this paragraph to three thousand dollars per hearing aid for each
     3  hearing-impaired ear every twenty-four months.
     4    (ii)  an  insured or enrolled individual may choose a hearing aid that
     5  is priced higher than the benefit payable under this paragraph  and  may
     6  pay  the difference between the price of the hearing aid and the benefit
     7  payable under this paragraph without financial or contractual penalty to
     8  the provider of the hearing aid.
     9    (iii) in the case of a health insurer  or  managed  care  organization
    10  that  administers  benefits  according  to  contracts  with  health care
    11  providers, hearing aids covered pursuant  to  this  paragraph  shall  be
    12  obtained  from  health care providers contracted with the health insurer
    13  or managed care organization. Such providers shall  be  subject  to  the
    14  same  contracting  and  credentialing  requirements  that apply to other
    15  contracted health care providers.
    16    (D) This  paragraph  does  not  prohibit  an  entity  subject  to  the
    17  provisions  of this paragraph from providing coverage that is greater or
    18  more favorable to an insured or enrolled individual  than  the  coverage
    19  required under this paragraph.
    20    (E)  The  provisions  of this paragraph shall apply to any new policy,
    21  contract, program, or plan issued by an entity subject to the provisions
    22  of this paragraph on or after January first,  two  thousand  twenty-one.
    23  Any  such  policy,  contract, program or plan in effect prior to January
    24  first, two thousand twenty-one shall convert to the provisions  of  this
    25  paragraph  on  or  before the renewal date thereof but in no event later
    26  than January first, two thousand twenty-one. Any policy affected by  the
    27  provisions  of  this  paragraph shall apply to an insured or participant
    28  under such policy, contract, program, or plan whether or not the hearing
    29  impairment is a pre-existing condition of the insured or participant.
    30    § 2. Section 3221 of the insurance law is  amended  by  adding  a  new
    31  subsection (u) to read as follows:
    32    (u)  (1)  As  used in this subsection, "hearing aid" shall mean a non-
    33  disposable device that is of a design and circuitry to optimize audition
    34  and listening skills in the environment commonly  experienced  by  chil-
    35  dren.
    36    (2) This subsection shall apply to the following entities:
    37    (A)  Insurers and nonprofit health service plans, including the office
    38  of group benefits, that provide hospital, medical, or surgical  benefits
    39  to  individuals  or  groups  on  an  expense-incurred basis under health
    40  insurance policies or contracts that are issued  or  delivered  in  this
    41  state.
    42    (B)  Managed  care  organizations as defined and licensed by state law
    43  that provide hospital, medical or surgical benefits  to  individuals  or
    44  groups under contracts that are issued or delivered in this state.
    45    (3)  An  entity  subject to this subsection shall provide coverage for
    46  hearing aids for patients who are covered under a policy or contract  of
    47  insurance  if  the  hearing  aids are fitted and dispensed by a licensed
    48  audiologist certified by the  American  Speech-Language-Hearing  Associ-
    49  ation  following  medical  clearance by a physician licensed to practice
    50  medicine and an audiological evaluation medically appropriate to the age
    51  of the child, provided:
    52    (A) An entity subject to this subsection may limit the benefit payable
    53  under this subsection to three thousand dollars per hearing aid for each
    54  hearing-impaired ear every twenty-four months.
    55    (B) An insured or enrolled individual may choose a hearing aid that is
    56  priced higher than the benefit payable under this subsection and may pay

        A. 2325--A                          3
 
     1  the difference between the price of the  hearing  aid  and  the  benefit
     2  payably  under  this subsection without financial or contractual penalty
     3  to the provider of the hearing aid.
     4    (C)  In the case of a health insurer or managed care organization that
     5  administers benefits according to contracts with health care  providers,
     6  hearing  aids covered pursuant to this subsection shall be obtained from
     7  health care providers contracted with   the health  insurer  or  managed
     8  care organization. Such providers shall be subject to the same contract-
     9  ing and credentialing requirements that apply to other contracted health
    10  care providers.
    11    (4)  This  subsection  does  not  prohibit  an  entity  subject to the
    12  provisions of this subsection from providing coverage that is greater or
    13  more favorable to an insured or enrolled individual  than  the  coverage
    14  required under this subsection.
    15    (5)  The  provisions of this subsection shall apply to any new policy,
    16  contract, program, or plan issued by an entity subject to the provisions
    17  of this subsection on or after January first, two  thousand  twenty-one.
    18  Any  such  policy,  contract, program or plan in effect prior to January
    19  first, two thousand twenty-one shall convert to the provisions  of  this
    20  subsection  on  or before the renewal date thereof but in no event later
    21  than January first, two thousand twenty-one. Any policy affected by  the
    22  provisions  of  this subsection shall apply to an insured or participant
    23  under such policy, contract, program, or plan whether or not the hearing
    24  impairment is a pre-existing condition of the insured or participant.
    25    § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
    26  subsection (ss) to read as follows:
    27    (ss)(1)  As  used  in this subsection, "hearing aid" shall mean a non-
    28  disposable device that is of a design and circuitry to optimize audition
    29  and listening skills in the environment commonly  experienced  by  chil-
    30  dren.
    31    (2) This subsection shall apply to the following entities:
    32    (A)  Insurers and nonprofit health service plans, including the office
    33  of group benefits, that provide hospital, medical, or surgical  benefits
    34  to  individuals  or  groups  on  an  expense-incurred basis under health
    35  insurance policies or contracts that are issued  or  delivered  in  this
    36  state.
    37    (B)  Managed  care  organizations as defined and licensed by state law
    38  that provide hospital, medical or surgical benefits  to  individuals  or
    39  groups under contracts that are issued or delivered in this state.
    40    (3)  An  entity  subject to this subsection shall provide coverage for
    41  hearing aids for patients who are covered under a policy or contract  of
    42  insurance  if  the  hearing  aids are fitted and dispensed by a licensed
    43  audiologist certified by the  American  Speech-Language-Hearing  Associ-
    44  ation  following  medical  clearance by a physician licensed to practice
    45  medicine and an audiological evaluation medically appropriate to the age
    46  of the child, provided:
    47    (A) An entity subject to this subsection may limit the benefit payable
    48  under this subsection to three thousand dollars per hearing aid for each
    49  hearing-impaired ear every twenty-four months.
    50    (B) An insured or enrolled individual may choose a hearing aid that is
    51  priced  higher then the benefit payable under his subsection and may pay
    52  the difference between the price of the  hearing  aid  and  the  benefit
    53  payable  under  this subsection without financial or contractual penalty
    54  to the provider of the hearing aid.
    55    (C) In the case of the health insurer  or  managed  care  organization
    56  that  administers  benefits  according  to  contracts  with  health care

        A. 2325--A                          4
 
     1  providers, hearing aids covered pursuant to  this  subsection  shall  be
     2  obtained  from  health care providers contracted with the health insurer
     3  or managed care organization. Such providers shall  be  subject  to  the
     4  same  contracting  and  credentialing  requirements  that apply to other
     5  contracted health care providers.
     6    (4) This subsection  does  not  prohibit  an  entity  subject  to  the
     7  provisions of this subsection from providing coverage that is greater or
     8  more  favorable  to  an insured or enrolled individual than the coverage
     9  required under this subsection.
    10    (5) The provisions of this subsection shall apply to any  new  policy,
    11  contract, program, or plan issued by an entity subject to the provisions
    12  of  this  subsection on or after January first, two thousand twenty-one.
    13  Any such policy, contract, program or plan in effect  prior  to  January
    14  first,  two  thousand twenty-one shall convert to the provisions of this
    15  subsection on or before the renewal date thereof but in no  event  later
    16  than  January first, two thousand twenty-one. Any policy affected by the
    17  provision of this subsection shall apply to an  insured  or  participant
    18  under such policy, contract, program, or plan whether or not the hearing
    19  impairment is a pre-existing condition of the insured or participant.
    20    §  4.  This  act shall take effect on the ninetieth day after it shall
    21  have become a law. Effective immediately, the addition, amendment and/or
    22  repeal of any rule or regulation necessary  for  the  implementation  of
    23  this  act  on its effective date are authorized to be made and completed
    24  on or before such date.
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