Full Text of SB0071 97th General Assembly
SB0071sam001 97TH GENERAL ASSEMBLY | 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 | 3 | | line 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 | 5 | | insurer that amends, delivers, issues, or renews group accident | 6 | | and health policies providing coverage for hospital or medical | 7 | | treatment or services on an expense-incurred basis shall offer, | 8 | | for an additional premium and subject to the insurer's standard | 9 | | of insurability, optional coverage for the reasonable and | 10 | | necessary medical treatment for audiological services and | 11 | | hearing aids. This coverage shall only apply to hearing aids | 12 | | that are prescribed, filled, and dispensed by a licensed | 13 | | audiologist or a licensed physician. | 14 | | (c) Coverage provided under this Section may be subject to | 15 | | all applicable co-payments, co-insurance, deductibles, and
| 16 | | out-of-pocket limits, for up to $2,500 per hearing aid per | 17 | | insured's hearing impaired ear subject to the following
| 18 | | restrictions: | 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
| 10 | | to other general exclusions and limitations of the policy,
| 11 | | including coordination of benefits, participating provider
| 12 | | requirements, restrictions on services provided by family or | 13 | | household members, utilization review of health care services,
| 14 | | including review of medical necessity, case management,
| 15 | | experimental and investigational treatments, and other
managed | 16 | | care provisions. ".
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