Sen. Ira I. Silverstein

Filed: 3/5/2009

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 68

2     AMENDMENT NO. ______. Amend Senate Bill 68 as follows:
 
3 on page 1, line 7, by replacing "Coverage for hearing aids for
4 all" with "Audiological services."; and
 
5 on page 1, by deleting line 8; and
 
6 on page 2, by replacing line 1 through line 26 with the
7 following:
8     "(b) An individual or group policy of accident and health
9 insurance or managed care plan that is amended, delivered,
10 issued, or renewed after the effective date of this amendatory
11 Act of the 96th General Assembly must provide coverage for
12 audiological services, hearing instruments, and related
13 services for children up to 18 years of age or 23 years of age
14 if enrolled in a post secondary educational program when a
15 hearing care professional prescribes, fits, and dispenses a

 

 

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1 hearing instrument to augment communication.
2     (c) An insurer shall provide coverage, subject to all
3 applicable co-payments, co-insurance, deductibles, and
4 out-of-pocket limits for up to $2,000 per hearing impaired ear
5 per coverage period subject to the following restrictions:
6         (1) a policy or plan may limit the hearing aid benefit
7     coverage period for each hearing-impaired ear to 36 months;
8         (2) the coverage shall provide for a benefit of $2,000
9     per hearing-impaired ear per coverage period and
10     guarantors shall be contractually allowed to pay the
11     difference between the benefit amount and the health care
12     professional's usual and customary charge for the device;
13         (3) the benefit may be used to cover hearing aids,
14     assistive-listening devices, hearing-aid accessories,
15     hearing-aid repairs, earmolds, and remote controls that
16     are prescribed and dispensed by a health care professional;
17         (4) a policy or plan may provide for up to 4 additional
18     ear molds per year at $50 each for children up to 5 years
19     of age; and
20         (5) for all insured individuals, any hearing aid may be
21     replaced at any time regardless of the above restrictions
22     if there is a significant change in the insured
23     individual's hearing status; such significant change is
24     defined as a change of 10 decibels HL on the
25     three-frequency pure-tone average (500Hz, 1000 Hz and 2000
26     Hz) on a valid audiogram provided by a hearing care

 

 

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1     professional."; and
 
2 on page 3, by deleting line 1.