2016 -- H 7363

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LC003878

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

RELATING TO INSURANCE - HEARING AIDS

     Introduced By: Representatives Jacquard, and Handy

     Date Introduced: January 28, 2016

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18-60 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-60. Hearing aids. -- (a) (1) Every individual or group health insurance contract, or

every individual or group hospital or medical expense insurance policy, plan, or group policy

delivered, issued for delivery, or renewed in this state on or after January 1, 2006 July 1, 2016,

shall provide coverage for one thousand five hundred dollars ($1,500) per an individual hearing

aid, per ear, every three (3) years for anyone under the age of nineteen (19) years, and shall

provide coverage for seven hundred dollars ($700) per individual hearing aid, per ear, every three

(3) years for anyone of the age of nineteen (19) years and older.; provided, that the hearing aid is

prescribed by a licensed audiologist as defined in §5-48-1.

     (2) The basic standard coverage shall include the following:

     (i) A hearing aid prescribed and dispensed by an audiologist or hearing aid dispenser

filling the prescription who is licensed by the Rhode Island department of health, and who

participates in the individual's health insurance plan;

     (ii) T-coil functionality if appropriate for the individual's needs;

     (iii) Earmold and its replacements; and

     (iv) Repair and replacement warranties, whichever is applicable, and follow-up services

which are clearly stated in the hearing aid sales agreement provided to the individual at the time

of the fitting.

     Upon receipt of an adverse determination regarding a hearing aid, the patient shall be

given written notice by the insurer of their right to a utilization review decision pursuant to

chapter 17.12 of title 23, ("healthcare services – utilization review act").

      (2)(3) Every group health insurance contract or group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on

or after January 1, 2006 July 1, 2016, shall provide, as an optional rider, additional hearing aid

coverage. Provided, the provisions of this paragraph shall not apply to contracts, plans, or group

policies subject to the small employer health insurance availability act, chapter 50 of this title.

      (b) For the purposes of this section:

      (1) "Hearing aid" means any nonexperimental, wearable instrument or device designed

for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but

excluding batteries, cords, and other assistive listening devices, including, but not limited to FM

systems.

      (c) It shall remain within the sole discretion of the accident and sickness insurer as to the

provider of hearing aids with which they choose to contract. Reimbursement shall be provided

according to the respective principles and policies of the accident and sickness insurer. Nothing

contained in this section precludes the accident and sickness insurer from conducting managed

care, medical necessity, or utilization review.

      (d) This section does not apply to insurance coverage providing benefits for: (1) hospital

confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare

supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of bodily

injury or death by accident or both; (9) and other limited benefit policies.

     SECTION 2. Section 27-19-51 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-51. Hearing aids. -- (a) (1) Every individual or group health insurance contract, or

every individual or group hospital or medical expense insurance policy, plan, or group policy

delivered, issued for delivery, or renewed in this state on or after January 1, 2006 July 1, 2016,

shall provide coverage for one thousand five hundred dollars ($1,500) per an individual hearing

aid, per ear, every three (3) years for anyone under the age of nineteen (19) years, and shall

provide coverage for seven hundred dollars ($700) per individual hearing aid, per ear, every three

(3) years for anyone of the age of nineteen (19) years and older.; provided, that the hearing aid is

prescribed by a licensed audiologist as defined in §5-48-1.

     (2) The basic standard coverage shall include the following:

     (i) A hearing aid prescribed and dispensed by an audiologist or hearing aid dispenser

LC003878 - Page 2 of 7

filling the prescription who is licensed by the Rhode Island department of health, and who

participates in the individual's health insurance plan;

     (ii) T-coil functionality if appropriate for the individual's needs;

     (iii) Earmold and its replacements; and

     (iv) Repair and replacement warranties, whichever is applicable, and follow-up services

which are clearly stated in the hearing aid sales agreement provided to the individual at the time

of the fitting.

     Upon receipt of an adverse determination regarding a hearing aid, the patient shall be

given written notice by the insurer of their right to a utilization review decision pursuant to

chapter 17.12 of title 23, ("healthcare services – utilization review act").

      (2)(3) Every group health insurance contract or group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on

or after January 1, 2006 July 1, 2016, shall provide, as an optional rider, additional hearing aid

coverage. Provided, the provisions of this paragraph shall not apply to contracts, plans, or group

policies subject to the small employer health insurance availability act, chapter 50 of this title.

      (b) For the purposes of this section:

      (1) "Hearing aid" means any nonexperimental, wearable instrument or device designed

for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but

excluding batteries, cords, and other assistive listening devices, including, but not limited to FM

systems.

      (c) It shall remain within the sole discretion of the accident and sickness insurer as to the

provider of hearing aids with which they choose to contract. Reimbursement shall be provided

according to the respective principles and policies of the accident and sickness insurer. Nothing

contained in this section precludes the accident and sickness insurer from conducting managed

care, medical necessity, or utilization review.

      (d) This section does not apply to insurance coverage providing benefits for: (1) hospital

confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare

supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of bodily

injury or death by accident or both; (9) and other limited benefit policies.

     SECTION 3. Section 27-20-46 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-46. Hearing aids. -- (a) (1) Every individual or group health insurance contract, or

every individual or group hospital or medical expense insurance policy, plan, or group policy

delivered, issued for delivery, or renewed in this state on or after January 1, 2006 July 1, 2016,

LC003878 - Page 3 of 7

shall provide coverage for one thousand five hundred dollars ($1,500) per an individual hearing

aid, per ear, every three (3) years for anyone under the age of nineteen (19) years, and shall

provide coverage for seven hundred dollars ($700) per individual hearing aid, per ear, every three

(3) years for anyone of the age of nineteen (19) years and older.; provided, that the hearing aid is

prescribed by a licensed audiologist as defined in §5-48-1.

     (2) The basic standard coverage shall include the following:

     (i) A hearing aid prescribed and dispensed by an audiologist or hearing aid dispenser

filling the prescription who is licensed by the Rhode Island department of health, and who

participates in the individual's health insurance plan;

     (ii) T-coil functionality if appropriate for the individual's needs;

     (iii) Earmold and its replacements; and

     (iv) Repair and replacement warranties, whichever is applicable, and follow-up services

which are clearly stated in the hearing aid sales agreement provided to the individual at the time

of the fitting.

     Upon receipt of an adverse determination regarding a hearing aid, the patient shall be

given written notice by the insurer of their right to a utilization review decision pursuant to

chapter 17.12 of title 23, ("healthcare services – utilization review act").

      (2)(3) Every group health insurance contract or group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on

or after January 1, 2006 July 1, 2016, shall provide, as an optional rider, additional hearing aid

coverage. Provided, the provisions of this paragraph shall not apply to contracts, plans, or group

policies subject to the small employer health insurance availability act, chapter 50 of this title.

      (b) For the purposes of this section:

      (1) "Hearing aid" means any nonexperimental, wearable instrument or device designed

for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but

excluding batteries, cords, and other assistive listening devices, including, but not limited to FM

systems.

      (c) It shall remain within the sole discretion of the accident and sickness insurer as to the

provider of hearing aids with which they choose to contract. Reimbursement shall be provided

according to the respective principles and policies of the accident and sickness insurer. Nothing

contained in this section precludes the accident and sickness insurer from conducting managed

care, medical necessity, or utilization review.

      (d) This section does not apply to insurance coverage providing benefits for: (1) hospital

confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare

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supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of bodily

injury or death by accident or both; (9) and other limited benefit policies.

     SECTION 4. Section 27-41-63 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-63. Hearing aids. -- (a) (1) Every individual or group health insurance contract, or

every individual or group hospital or medical expense insurance policy, plan, or group policy

delivered, issued for delivery, or renewed in this state on or after January 1, 2006 July 1, 2016,

shall provide coverage for one thousand five hundred dollars ($1,500) per an individual hearing

aid, per ear, every three (3) years for anyone under the age of nineteen (19) years, and shall

provide coverage for seven hundred dollars ($700) per individual hearing aid, per ear, every three

(3) years for anyone of the age of nineteen (19) years and older.; provided, that the hearing aid is

prescribed by a licensed audiologist as defined in §5-48-1.

     (2) The basic standard coverage shall include the following:

     (i) A hearing aid prescribed and dispensed by an audiologist or hearing aid dispenser

filling the prescription who is licensed by the Rhode Island department of health, and who

participates in the individual's health insurance plan;

     (ii) T-coil functionality if appropriate for the individual's needs;

     (iii) Earmold and its replacements; and

     (iv) Repair and replacement warranties, whichever is applicable, and follow-up services

which are clearly stated in the hearing aid sales agreement provided to the individual at the time

of the fitting.

     Upon receipt of an adverse determination regarding a hearing aid, the patient shall be

given written notice by the insurer of their right to a utilization review decision pursuant to

chapter 17.12 of title 23, ("healthcare services – utilization review act").

      (2)(3) Every group health insurance contract or group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on

or after January 1, 2006 July 1, 2016, shall provide, as an optional rider, additional hearing aid

coverage. Provided, the provisions of this paragraph shall not apply to contracts, plans, or group

policies subject to the small employer health insurance availability act, chapter 50 of this title.

      (b) For the purposes of this section:

      (1) "Hearing aid" means any nonexperimental, wearable instrument or device designed

for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but

excluding batteries, cords, and other assistive listening devices, including, but not limited to FM

systems.

LC003878 - Page 5 of 7

      (c) It shall remain within the sole discretion of the accident and sickness insurer as to the

provider of hearing aids with which they choose to contract. Reimbursement shall be provided

according to the respective principles and policies of the accident and sickness insurer. Nothing

contained in this section precludes the accident and sickness insurer from conducting managed

care, medical necessity, or utilization review.

      (d) This section does not apply to insurance coverage providing benefits for: (1) hospital

confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare

supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of bodily

injury or death by accident or both; (9) and other limited benefit policies.

     SECTION 5. This act shall take effect upon passage.

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LC003878

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - HEARING AIDS

***

     This act would expand the required health insurance coverage for hearing aids.

     This act would take effect upon passage.

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LC003878

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