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Public Act 103-0530 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Insurance Code is amended by | ||||
changing Section 356z.30 as follows: | ||||
(215 ILCS 5/356z.30) | ||||
Sec. 356z.30. Coverage for hearing aids for individuals | ||||
under the age of 18 . | ||||
(a) As used in this Section: | ||||
"Hearing care professional" means a person who is a
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licensed hearing instrument dispenser, licensed audiologist, | ||||
or licensed physician. | ||||
"Hearing instrument" or "hearing aid" means any wearable
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non-disposable, non-experimental instrument or device designed | ||||
to aid or
compensate for impaired human hearing and any parts, | ||||
attachments, or accessories for the instrument or device, | ||||
including
an ear mold but excluding batteries and cords. | ||||
(b) An individual or group policy of accident and health
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insurance or managed care plan that is amended, delivered,
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issued, or renewed after the effective date of this amendatory | ||||
Act of the 103rd General Assembly August 22, 2018 (the | ||||
effective date of Public Act 100-1026) must provide coverage | ||||
for
medically necessary hearing instruments and related |
services for all individuals under the age of 18
when a hearing | ||
care professional prescribes a hearing instrument to augment | ||
communication. | ||
(c) An insurer shall provide coverage, subject to all | ||
applicable co-payments, co-insurance, deductibles, and | ||
out-of-pocket limits, subject to the following restrictions: | ||
(1) one hearing instrument shall be covered for each | ||
ear every 36 months; | ||
(2) related services, such as audiological exams and | ||
selection, fitting, and adjustment of ear molds to | ||
maintain optimal fit shall be covered when deemed | ||
medically necessary by a hearing care professional; and | ||
(3) hearing instrument repairs may be covered when | ||
deemed medically necessary. | ||
(d) If, at any time before or after the effective date of | ||
this amendatory Act of the 103rd General Assembly August 22, | ||
2018 (the effective date of Public Act 100-1026) , the | ||
Secretary of the United States Department of Health and Human | ||
Services, or its successor agency, promulgates rules or | ||
regulations to be published in the Federal Register, publishes | ||
a comment in the Federal Register, or issues an opinion, | ||
guidance, or other action that would require the State, | ||
pursuant to any provision of the Patient Protection and | ||
Affordable Care Act (Pub. L. 111–148), including, but not | ||
limited to, 42 U.S.C. 18031(d)(3)(B) or any successor | ||
provision, to defray the cost of coverage for medically |
necessary hearing instruments and related services for any | ||
individual individuals under the age of 18 , then this Section | ||
is inoperative with respect to all such coverage other than | ||
that authorized under Section 1902 of the Social Security Act, | ||
42 U.S.C. 1396a, and the State shall not assume any obligation | ||
for the cost of coverage for medically necessary hearing | ||
instruments and related services for any individual subject to | ||
federally defrayed cost of coverage individuals under the age | ||
of 18 .
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(Source: P.A. 100-1026, eff. 8-22-18; 101-81, eff. 7-12-19.)
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Section 99. Effective date. This Act takes effect January | ||
1, 2025.
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