Sen. Ira I. Silverstein

Filed: 3/7/2011

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 71

2    AMENDMENT NO. ______. Amend Senate Bill 71 by replacing
3line 6 on page 1 through line 6 on page 3 with the following:
 
4    "(215 ILCS 5/356z.19 new)
5    Sec. 356z.19. Hearing aid coverage offer.
6    (a) As used in this Section:
7        "Audiological services" means those services medically
8    necessary pursuant to accepted professional medical or
9    audiological standards to assess, select, and adjust or fit
10    the hearing instrument to ensure optimal performance,
11    including, but not limited to, audiological exams,
12    replacement ear molds, and repairs to the hearing
13    instrument.
14        "Hearing aid" means any wearable, non-disposable
15    instrument or device designed to aid or compensate for
16    impaired human hearing in cases where functional ability
17    cannot be restored either medically or surgically and any

 

 

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1    parts, attachments, or accessories for the instrument or
2    device, including an ear mold but excluding batteries and
3    cords.
4    (b) On or after the effective date of this Section, every
5insurer that amends, delivers, issues, or renews group accident
6and health policies providing coverage for hospital or medical
7treatment or services on an expense-incurred basis shall offer,
8for an additional premium and subject to the insurer's standard
9of insurability, optional coverage for the reasonable and
10necessary medical treatment for audiological services and
11hearing aids. This coverage shall only apply to hearing aids
12that are prescribed, filled, and dispensed by a licensed
13audiologist or a licensed physician.
14    (c) Coverage provided under this Section may be subject to
15all applicable co-payments, co-insurance, deductibles, and
16out-of-pocket limits, for up to $2,500 per hearing aid per
17insured's hearing impaired ear subject to the following
18restrictions:
19        (1) for all insured individuals, hearing aids may be
20    replaced up to once every 38 months as prescribed and
21    dispensed by a licensed audiologist or licensed physician;
22        (2) for all insured individuals, any hearing aid may be
23    replaced at any time regardless of the restrictions of item
24    (1) of this subsection (c) if there is a significant change
25    in the insured individual's hearing status; such
26    significant change is defined as a change of 10 decibels HL

 

 

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1    on the 3-frequency pure-tone average (500 Hz, 1000 Hz, and
2    2000 Hz) on a valid audiogram provided by a licensed
3    audiologist or licensed physician;
4        (3) for children up to 2 years of age, additional ear
5    molds may be replaced up to 4 times per year; and
6        (4) for all insured individuals, audiological services
7    shall be covered at all times when prescribed by a licensed
8    audiologist or licensed physician.
9    (d) The coverage required by this Section shall be subject
10to other general exclusions and limitations of the policy,
11including coordination of benefits, participating provider
12requirements, restrictions on services provided by family or
13household members, utilization review of health care services,
14including review of medical necessity, case management,
15experimental and investigational treatments, and other managed
16care provisions.".