Sen. Ira I. Silverstein
Filed: 5/4/2010
 
 

 




 

 		












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AMENDMENT TO HOUSE BILL 5407 




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    AMENDMENT NO. ______. Amend House Bill 5407 by replacing 
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everything after the enacting clause with the following:

 
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    "Section 5. The Illinois Insurance Code is amended  by 
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renumbering and changing Section 356z.15, as added by Public 
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Act 96-180, and  by adding Section 356z.19 as follows:
 
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    "(215 ILCS 5/356z.16)
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    Sec. 356z.16 356z.15. Applicability of mandated benefits 
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to supplemental policies. Unless specified otherwise, the 
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following Sections of the Illinois Insurance Code do not apply 
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to short-term travel, disability income, long-term care, 
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accident only, or limited or specified disease policies: 356b, 
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356c, 356d, 356g, 356k, 356m, 356n, 356p, 356q, 356r, 356t, 
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356u, 356w, 356x, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 
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356z.8, 356z.19, 367.2-5, and 367e.

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(Source: P.A. 96-180, eff. 1-1-10; revised 10-21-09.)".
 
 


 






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    "(215 ILCS 5/356z.19 new)
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    Sec. 356z.19. Hearing aid coverage offer. 
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    (a) As used in this Section:
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        "Audiological services" means those services medically 
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    necessary pursuant to accepted professional medical or 
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    audiological standards to assess, select, and adjust or fit 
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    the hearing instrument to ensure optimal performance, 
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    including, but not limited to, audiological exams, 
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    replacement ear molds, and repairs to the hearing 
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    instrument.
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        "Hearing aid" means any wearable, non-disposable 
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    instrument or device designed to aid or compensate for 
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    impaired human hearing in cases where functional ability 
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    cannot be restored either medically or surgically and any 
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    parts, attachments, or accessories for the instrument or 
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    device, including an ear mold but excluding batteries and 
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    cords.
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    (b) On or after the effective date of this Section, every 
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insurer that amends, delivers, issues, or renews group accident 
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and health policies providing coverage for hospital or medical 
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treatment or services on an expense-incurred basis shall offer, 
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for an additional premium and subject to the insurer's standard 
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of insurability, optional coverage for the reasonable and 
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necessary medical treatment for audiological services and 
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hearing aids. This coverage shall only apply to hearing aids 
 


 






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that are prescribed, filled, or dispensed by a licensed 
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audiologist or a licensed physician.
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    (c) Coverage provided under this Section may be subject to 
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all applicable copayments, coinsurance, deductibles, and

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out-of-pocket limits, for up to $2,500 per hearing aid per 
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insured's hearing impaired ear subject to the following

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restrictions:
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        (1) for all insured individuals, hearing aids may be

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    replaced up to once every 36 months as prescribed and

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    dispensed by a licensed audiologist or licensed physician;
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        (2) for all insured individuals, hearing aids may be

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    replaced at any time upon accident, illness, or injury to 
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    the insured as provided in the policy;
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        (3) for children up to 2 years of age, additional ear 
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    molds may be replaced up to 4 times per year; and
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        (4) for all insured individuals, audiological services 
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    shall be covered at all times when prescribed by a licensed 
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    audiologist or licensed physician.
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    (d) The coverage required by this Section shall be subject

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to other general exclusions and limitations of the policy,

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including coordination of benefits, participating provider

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requirements, restrictions on services provided by family or 
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household members, utilization review of health care services,

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including review of medical necessity, case management,

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experimental and investigational treatments, and other
managed 
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care provisions.
 


 






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    (e) This Section does not  prohibit a covered individual 
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from choosing a hearing aid that exceeds the covered amount 
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provided in the policy.  If the covered individual chooses a 
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hearing aid that exceeds the amount specified in the policy, 
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then the covered individual is responsible for any difference 
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between the policy benefit and the cost of the hearing aid. 
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Prior to a covered individual selecting a hearing aid that 
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exceeds the covered amount in the policy, the provider of the 
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hearing aid shall provide a written estimate of the financial 
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liability of the covered individual.".