SB0071sam001 97TH GENERAL ASSEMBLY

Sen. Ira I. Silverstein

Filed: 3/7/2011

09700SB0071sam001 LRB097 02743 RPM 52182 a

AMENDMENT TO SENATE BILL 71

AMENDMENT NO. ______. Amend Senate Bill 71 by replacing line 6 on page 1 through line 6 on page 3 with the following:

"(215 ILCS 5/356z.19 new)

Sec. 356z.19. Hearing aid coverage offer.

(a) As used in this Section:

"Audiological services" means those services medically necessary pursuant to accepted professional medical or audiological standards to assess, select, and adjust or fit the hearing instrument to ensure optimal performance, including, but not limited to, audiological exams, replacement ear molds, and repairs to the hearing instrument.

"Hearing aid" means any wearable, non-disposable instrument or device designed to aid or compensate for impaired human hearing in cases where functional ability cannot be restored either medically or surgically and any parts, attachments, or accessories for the instrument or device, including an ear mold but excluding batteries and cords.

(b) On or after the effective date of this Section, every insurer that amends, delivers, issues, or renews group accident and health policies providing coverage for hospital or medical treatment or services on an expense-incurred basis shall offer, for an additional premium and subject to the insurer's standard of insurability, optional coverage for the reasonable and necessary medical treatment for audiological services and hearing aids. This coverage shall only apply to hearing aids that are prescribed, filled, and dispensed by a licensed audiologist or a licensed physician.

(c) Coverage provided under this Section may be subject to all applicable co-payments, co-insurance, deductibles, and out-of-pocket limits, for up to $2,500 per hearing aid per insured's hearing impaired ear subject to the following restrictions:

(1) for all insured individuals, hearing aids may be replaced up to once every 38 months as prescribed and dispensed by a licensed audiologist or licensed physician;

(2) for all insured individuals, any hearing aid may be replaced at any time regardless of the restrictions of item (1) of this subsection (c) if there is a significant change in the insured individual's hearing status; such significant change is defined as a change of 10 decibels HL on the 3-frequency pure-tone average (500 Hz, 1000 Hz, and 2000 Hz) on a valid audiogram provided by a licensed audiologist or licensed physician;

(3) for children up to 2 years of age, additional ear molds may be replaced up to 4 times per year; and

(4) for all insured individuals, audiological services shall be covered at all times when prescribed by a licensed audiologist or licensed physician.

(d) The coverage required by this Section shall be subject to other general exclusions and limitations of the policy, including coordination of benefits, participating provider requirements, restrictions on services provided by family or household members, utilization review of health care services, including review of medical necessity, case management, experimental and investigational treatments, and other managed care provisions.".