|
|
Sen. Ira I. Silverstein
Filed: 5/4/2010
|
|
09600HB5407sam001 |
|
LRB096 17948 RPM 41108 a |
|
|
| 1 |
| AMENDMENT TO HOUSE BILL 5407
|
| 2 |
| AMENDMENT NO. ______. Amend House Bill 5407 by replacing |
| 3 |
| everything after the enacting clause with the following:
|
| 4 |
| "Section 5. The Illinois Insurance Code is amended by |
| 5 |
| renumbering and changing Section 356z.15, as added by Public |
| 6 |
| Act 96-180, and by adding Section 356z.19 as follows:
|
| 7 |
| "(215 ILCS 5/356z.16) |
| 8 |
| Sec. 356z.16 356z.15. Applicability of mandated benefits |
| 9 |
| to supplemental policies. Unless specified otherwise, the |
| 10 |
| following Sections of the Illinois Insurance Code do not apply |
| 11 |
| to short-term travel, disability income, long-term care, |
| 12 |
| accident only, or limited or specified disease policies: 356b, |
| 13 |
| 356c, 356d, 356g, 356k, 356m, 356n, 356p, 356q, 356r, 356t, |
| 14 |
| 356u, 356w, 356x, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, |
| 15 |
| 356z.8, 356z.19, 367.2-5, and 367e.
|
| 16 |
| (Source: P.A. 96-180, eff. 1-1-10; revised 10-21-09.)".
|
|
|
|
09600HB5407sam001 |
- 2 - |
LRB096 17948 RPM 41108 a |
|
|
| 1 |
| "(215 ILCS 5/356z.19 new) |
| 2 |
| Sec. 356z.19. Hearing aid coverage offer. |
| 3 |
| (a) As used in this Section: |
| 4 |
| "Audiological services" means those services medically |
| 5 |
| necessary pursuant to accepted professional medical or |
| 6 |
| audiological standards to assess, select, and adjust or fit |
| 7 |
| the hearing instrument to ensure optimal performance, |
| 8 |
| including, but not limited to, audiological exams, |
| 9 |
| replacement ear molds, and repairs to the hearing |
| 10 |
| instrument. |
| 11 |
| "Hearing aid" means any wearable, non-disposable |
| 12 |
| instrument or device designed to aid or compensate for |
| 13 |
| impaired human hearing in cases where functional ability |
| 14 |
| cannot be restored either medically or surgically and any |
| 15 |
| parts, attachments, or accessories for the instrument or |
| 16 |
| device, including an ear mold but excluding batteries and |
| 17 |
| cords. |
| 18 |
| (b) On or after the effective date of this Section, every |
| 19 |
| insurer that amends, delivers, issues, or renews group accident |
| 20 |
| and health policies providing coverage for hospital or medical |
| 21 |
| treatment or services on an expense-incurred basis shall offer, |
| 22 |
| for an additional premium and subject to the insurer's standard |
| 23 |
| of insurability, optional coverage for the reasonable and |
| 24 |
| necessary medical treatment for audiological services and |
| 25 |
| hearing aids. This coverage shall only apply to hearing aids |
|
|
|
09600HB5407sam001 |
- 3 - |
LRB096 17948 RPM 41108 a |
|
|
| 1 |
| that are prescribed, filled, or dispensed by a licensed |
| 2 |
| audiologist or a licensed physician. |
| 3 |
| (c) Coverage provided under this Section may be subject to |
| 4 |
| all applicable copayments, coinsurance, deductibles, and
|
| 5 |
| out-of-pocket limits, for up to $2,500 per hearing aid per |
| 6 |
| insured's hearing impaired ear subject to the following
|
| 7 |
| restrictions: |
| 8 |
| (1) for all insured individuals, hearing aids may be
|
| 9 |
| replaced up to once every 36 months as prescribed and
|
| 10 |
| dispensed by a licensed audiologist or licensed physician; |
| 11 |
| (2) for all insured individuals, hearing aids may be
|
| 12 |
| replaced at any time upon accident, illness, or injury to |
| 13 |
| the insured as provided in the policy; |
| 14 |
| (3) for children up to 2 years of age, additional ear |
| 15 |
| molds may be replaced up to 4 times per year; and |
| 16 |
| (4) for all insured individuals, audiological services |
| 17 |
| shall be covered at all times when prescribed by a licensed |
| 18 |
| audiologist or licensed physician. |
| 19 |
| (d) The coverage required by this Section shall be subject
|
| 20 |
| to other general exclusions and limitations of the policy,
|
| 21 |
| including coordination of benefits, participating provider
|
| 22 |
| requirements, restrictions on services provided by family or |
| 23 |
| household members, utilization review of health care services,
|
| 24 |
| including review of medical necessity, case management,
|
| 25 |
| experimental and investigational treatments, and other
managed |
| 26 |
| care provisions. |
|
|
|
09600HB5407sam001 |
- 4 - |
LRB096 17948 RPM 41108 a |
|
|
| 1 |
| (e) This Section does not prohibit a covered individual |
| 2 |
| from choosing a hearing aid that exceeds the covered amount |
| 3 |
| provided in the policy. If the covered individual chooses a |
| 4 |
| hearing aid that exceeds the amount specified in the policy, |
| 5 |
| then the covered individual is responsible for any difference |
| 6 |
| between the policy benefit and the cost of the hearing aid. |
| 7 |
| Prior to a covered individual selecting a hearing aid that |
| 8 |
| exceeds the covered amount in the policy, the provider of the |
| 9 |
| hearing aid shall provide a written estimate of the financial |
| 10 |
| liability of the covered individual.".
|