SB2838 104TH GENERAL ASSEMBLY

LRB104 17737 BAB 31168 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB2838

Introduced 1/13/2026, by Sen. Julie A. Morrison

SYNOPSIS AS INTRODUCED:

215 ILCS 5/Art. XLVIII heading new
215 ILCS 5/1800 new
215 ILCS 5/1805 new
215 ILCS 5/1810 new
815 ILCS 505/2MMMM new

Amends the Illinois Insurance Code to create the Hearing Care Plan Contracts Article. Provides that no hearing care organization that issues, delivers, amends, or renews a hearing care plan on or after the effective date of the amendatory Act shall issue a contract that requires a hearing instrument professional, as a condition of participation in the hearing care plan, to provide items or services to an enrollee at a fee set by the hearing care plan unless the items and services are covered items or covered services under the hearing care plan. Exempts de minimis reimbursements. Establishes notice and disclosure provisions for a hearing instrument professional who chooses not to accept as payment an amount set by a hearing care plan for items and services that are not covered and other hearing care plan contract requirements. Provides that, beginning on January 1, 2027, to conduct business in the State, a hearing care organization must register with the Department of Insurance and submit the specified registration materials. Requires the registrant to report any specified change in information to the Department in writing within 60 days after the change occurs. Sets forth provisions concerning issuance and expiration of a registration certificate. Grants the Department of Insurance rulemaking authority over the registration provisions. Amends the Consumer Fraud and Deceptive Business Practices Act to make it an unlawful practice under the meaning of the Act for any person to violate the Hearing Plan Contracts Article of the Illinois Insurance Code. Effective January 1, 2027.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Insurance Code is amended by adding Article XLVIII as follows:

(215 ILCS 5/Art. XLVIII heading new)

ARTICLE XLVIII. HEARING CARE PLAN CONTRACTS

(215 ILCS 5/1800 new)

Sec. 1800. Definitions. In this Article:

"Copayment, coinsurance, or deductible" means the dollar amount the enrollee must contribute, out of pocket, toward the costs of covered items and covered services listed as hearing care benefits in a hearing care plan.

"Covered items" means items for which reimbursement from the hearing care plan is provided to a hearing instrument professional by an enrollee's plan contract or for which a reimbursement would be available, but for the application of the enrollee's contractual limitation of deductibles, copayments, or coinsurance.

"Covered items" includes, but is not limited to, prescription hearing aids, earmolds, domes or inserts, assistive listening devices, and hearing aid supplies and accessories. "Covered items" does not include over-the-counter hearing aids as defined in 21 CFR 800.30(b).

"Covered services" means services for which reimbursement from the hearing care plan is provided to a hearing instrument professional by an enrollee's plan contract or for which a reimbursement would be available but for the application of the enrollee's contractual plan or summary of benefit limitation of copayments, coinsurance, or deductibles.

"Discount or unfunded hearing care benefit" means a hearing care benefit that is offered in the enrollee's plan contract but is not funded, in whole or in part, by the hearing care organization, hearing care plan, employer, or labor union.

"Enrollee" means any individual enrolled in a hearing care plan provided by a group, employer, or other entity that purchases or supplies coverage for a hearing care plan.

"Funded hearing care benefit" means hearing care benefits that are offered in the enrollee's plan contract and are funded, in whole or in part, by the hearing care organization, hearing care plan, employer, or labor union.

"Hearing care benefits" means the covered items or covered services listed in an enrollee's plan contract or plan documents.

"Hearing care organization" means an entity formed under the laws of this State or another state that issues a hearing care plan.

"Hearing care plan" means a plan that creates, promotes, markets, sells, advertises, or administers an integrated or stand-alone plan that provides coverage for covered items and covered services.

"Hearing instrument professional" means a person who is licensed in this State as an audiologist, a hearing instrument dispenser, or a physician.

"Manufacturer" means the company that manufactures and distributes hearing aids, earmolds, domes or inserts, assistive listening devices, and hearing aid supplies and accessories.

"Noncovered items and services" means items and services that are not funded or covered by the enrollee's hearing care plan and where the enrollee is fully responsible for the cost of the item or service.

"Prescription hearing aid" means any instrument or device, including an instrument or device dispensed pursuant to a prescription or order, that is designed, intended, or offered for the purpose of improving a person's hearing and any parts, attachments, or accessories, including earmolds.

"Prescription hearing aid" does not include batteries, cords, and individual or group auditory training devices and any instrument or device used by a public utility in providing telephone or other communication services.

"Routine hearing care services" means services that lack medical necessity, such as pass or fail hearing screenings that are used to determine the need for additional diagnostic hearing testing.

"Subcontractor" means any company, group, or third-party entity, including agents, servants, partially owned or wholly owned subsidiaries, and controlled organizations, that the hearing care plan contracts with to supply items or service for a hearing instrument professional or enrollee to fulfill the benefit plan of a hearing care plan.

(215 ILCS 5/1805 new)

Sec. 1805. Health care plan contracts.

(a) No hearing care organization that issues, delivers, amends, or renews a hearing care plan on or after the effective date of this amendatory Act of the 104th General Assembly shall issue a contract that requires a hearing instrument professional, as a condition of participation in the hearing care plan, to provide items or services to an enrollee at a fee set by the hearing care plan unless the items and services are covered items or covered services under the hearing care plan. De minimis reimbursements shall not qualify an item or service as a covered item or service under this Article.

(b) A hearing instrument professional who chooses not to accept as payment an amount set by a hearing care plan for items and services that are not covered, in whole, by the hearing care plan shall:

(1) post, in a conspicuous place, a notice stating the following: "IMPORTANT: This hearing instrument professional does not accept the fee schedule set by your hearing care plan for hearing care items and services that are not covered benefits under your plan, when the item or service is provided prior to the hearing aid fitting, after one year following the initial fitting of the hearing aids, or after all of the allowed service visits are exhausted. In these cases, the hearing instrument professional may charge his or her usual and customary fees for those items and services. This hearing instrument professional will provide you with an estimated cost for each noncovered item or service in accordance with the No Surprises Act."; or

(2) provide the information required under paragraph (1) in a document provided by the hearing instrument professional to the patient.

(c) Hearing care benefits must be communicated in writing by the hearing care organization to an enrollee, prospective enrollee, and the hearing instrument professional. Noncovered items and noncovered services must be identified in the hearing care plan's marketing materials, contract, and plan documents. If coverage of a specific item or service is not stated, it will be considered a noncovered service or noncovered item.

(d) No hearing care organization or its officers, directors, agents, and employees may represent a discount or unfunded hearing care benefit as a funded hearing care benefit and must clearly list and document, in the definition of benefits and in marketing materials and plan documents, the specific dollar benefit amounts, copayments, coinsurance, or deductibles applicable to hearing care benefits provided by both in-network and out-of-network providers.

(e) A hearing care plan may enter into an agreement with a health care plan to provide hearing care benefits that include routine hearing care services and medically necessary diagnostic hearing services in accordance with guidance promulgated by the Centers for Medicare and Medicaid Services. If hearing care benefits include routine hearing testing for the purpose of fitting or modifying a hearing aid, the hearing instrument professional shall be reimbursed for the costs of performing the testing regardless of whether the enrollee proceeds with the purchase of a prescription hearing aid.

(f) If a hearing care plan is owned and operated, in whole or in part, by a hearing aid manufacturer and that manufacturer offers prescription hearing aids within the hearing care benefits or hearing care plan, that hearing care plan must disclose, on its websites for enrollees or potential enrollees, in its marketing communications, and in its benefits or plan documents, their ownership or operational interest and specify which prescription hearing aids are available within the hearing care plan it manufacturers or distributes.

(g) An enrollee is financially responsible for the total allowed costs or copayment of hearing care benefits at a discounted rate solely determined by the hearing care organization, including hearing care plans where the plan assigns a copayment or coinsurance to the claim and where the enrollee pays a copayment or coinsurance amount that exceeds 20% of the total allowable rates of prescribed prescription hearing aids and related items and services. The enrollee may be subject to applicable copayments, coinsurance, or deductibles, including hearing care plans where the plan assigns a copayment or coinsurance to the claim and where the enrollee pays a copayment or coinsurance amount that is less than 20% of the total cost of prescribed prescription hearing aids and related items and services.

(h) The provisions of this Act apply to any subcontractors used by a hearing care organization to supply items or services to a hearing instrument professional.

(215 ILCS 5/1810 new)

Sec. 1810. Health care plan licensure requirements.

(a) Beginning on January 1, 2027, to conduct business in this State, a hearing care organization must register with the Department. To initially register or to renew a registration, a hearing care organization must submit:

(1) A nonrefundable fee not to exceed $500.

(2) A copy of the registrant's corporate charter, articles of incorporation, or other charter document.

(3) A completed registration form adopted by the Department containing:

(A) The name and address of the registrant.

(B) The name, address, and official position of each officer and director of the registrant.

(b) The registrant shall report any change in information required under this Section to the Department in writing within 60 days after the change occurs.

(c) Upon receipt of a completed registration form, the required documents, and the registration fee, the Department shall issue a registration certificate. The certificate may be in paper or electronic form, and shall clearly indicate the expiration date of the registration. Registration certificates are nontransferable.

(d) A registration certificate is valid for 2 years after its date of issue. The Department shall adopt by rule an initial registration fee not to exceed $500 and a registration renewal fee not to exceed $500, both of which shall be nonrefundable.

(e) The Department may adopt any rules necessary to implement this Section.

Section 10. The Consumer Fraud and Deceptive Business Practices Act is amended by adding Section 2MMMM as follows:

(815 ILCS 505/2MMMM new)

Sec. 2MMMM. Violations of the Hearing Care Plan Contracts Article of the Illinois Insurance Code. Any person who violates Article XLVIII of the Illinois Insurance Code commits an unlawful practice within the meaning of this Act.

Section 99. Effective date. This Act takes effect January 1, 2027.