SB26 SUB1
Senate Bill 26 History
OTHER VERSIONS -
Introduced Version
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Key: Green = existing Code. Red = new code to be enacted
COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 26
(By Senators Stollings and Yost)
____________
[Originating in the Committee on Banking and Insurance;
reported February 26, 2013.]
____________
A BILL
to amend
the Code of West Virginia, 1931, as amended, by
adding thereto a new section, designated §5-16-7f; to amend
said code by adding thereto a new section,
designated §33-15-
4k; to amend said code by adding thereto a new section,
designated §33-16-3w; to amend said code by adding thereto a
new section, designated §33-24-7l; to amend said code by
adding thereto a new section, designated §33-25-8i; and to
amend said code by adding thereto a new section, designated
§33-25A-8k, all relating generally to requiring health
insurance coverage of
hearing aids for individuals under
eighteen years of age; providing for an effective date for
coverage; providing definitions; setting age limitations;
providing for coverage limits and time frames;
providing that
the provisions are only required to the extent required by
federal law
;
and modifying required benefits for accident and sickness insurance, group accident and sickness insurance,
hospital medical and dental corporations, health care
corporations, health maintenance organizations and
under the
West Virginia Public Employees Insurance Act.
Be it enacted by the Legislature of West Virginia:
That
the Code of West Virginia, 1931, as amended, be amended
by adding thereto a new section, designated §5-16-7f; that said
code be amended by adding thereto a new section
, designated §33-15-
4k; that said code be amended by adding
thereto a new section,
designated §33-16-3w;
that said code be amended by adding thereto
a new section, designated §33-24-7l; that said code be amended by
adding thereto a new section, designated §33-25-8i; and that said
code be amended by adding thereto a new section, designated §33-
25A-8k,
all to read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,
SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD OF PUBLIC WORKS;
MISCELLANEOUS AGENCIES, COMMISSIONS, OFFICES, PROGRAMS, ETC.
ARTICLE 16.
WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7f
. Required coverage for hearing aids.
(a) Notwithstanding any provision of any policy, provision,
contract, plan, or agreement applicable to this article, any entity
regulated by this article shall, on or after July 1, 2013, provide
coverage for the cost of hearing aids that are prescribed by a
licensed physician for individuals covered under the policy or plan who are under eighteen years of age. Coverage shall be as follows:
(1) Initial hearing aids and replacement hearing aids not
more frequently than every thirty-six months.
(2) New hearing aids when alterations to the existing hearing
aids cannot adequately meet the needs of the covered individual.
(3) Services, including audiometric testing, hearing aid
evaluations, fittings, and adjustments.
(b) For purposes of this section, "hearing aid" means any
wearable device or instrument or any combination thereof,
designated for, represented as or offered for sale for the purpose
of aiding, improving or compensating for defective or impaired
human hearing and shall include ear molds, parts, attachments or
other medically necessary accessories, but excluding batteries and
cords.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered individuals
apply to hearing aids covered pursuant to this section. Required
coverage is further limited to the cost of one hearing aid
including all covered hearing aid-related services
not to exceed an
aggregate of $1,400 per hearing-impaired ear every thirty-six
months. The insured may choose a higher priced hearing aid and may
pay the difference in cost above the $1,400 limit as provided in
this section without any financial or contractual penalty to the insured or to the provider of the hearing aid.
(d) To the extent that the provisions of this section require
benefits that exceed the essential health benefits specified under
section 1302(b) of the Patient Protection and Affordable Care Act,
Pub. L. No. 111-148, as amended, the specific benefits that exceed
the specified essential heath benefits shall not be required of a
health benefit plan when the plan is offered by a health care
insurer in this state.
CHAPTER 33. INSURANCE.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4k. Required coverage for hearing aids.
(a) Notwithstanding any provision of any policy, provision,
contract, plan, or agreement applicable to this article, any entity
regulated by this article shall, on or after July 1, 2013, provide
coverage for the cost of hearing aids that are prescribed by a
licensed physician for individuals covered under the policy or plan
who are under eighteen years of age. Coverage shall be as follows:
(1) Initial hearing aids and replacement hearing aids not
more frequently than every thirty-six months.
(2) New hearing aids when alterations to the existing hearing
aids cannot adequately meet the needs of the covered individual.
(3) Services, including audiometric testing, hearing aid
evaluations, fittings, and adjustments.
(b) For purposes of this section, "hearing aid" means any wearable device or instrument or any combination thereof,
designated for, represented as or offered for sale for the purpose
of aiding, improving or compensating for defective or impaired
human hearing and shall include ear molds, parts, attachments or
other medically necessary accessories, but excluding batteries and
cords.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered individuals
apply to hearing aids covered pursuant to this section. Required
coverage is further limited to the cost of one hearing aid
including all covered hearing aid-related services
not to exceed an
aggregate of $1,400 per hearing-impaired ear every thirty-six
months. The insured may choose a higher priced hearing aid and may
pay the difference in cost above the $1,400 limit as provided in
this section without any financial or contractual penalty to the
insured or to the provider of the hearing aid.
(d) To the extent that the provisions of this section require
benefits that exceed the essential health benefits specified under
section 1302(b) of the Patient Protection and Affordable Care Act,
Pub. L. No. 111-148, as amended, the specific benefits that exceed
the specified essential heath benefits shall not be required of a
health benefit plan when the plan is offered by a health care
insurer in this state.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3w. Required coverage for hearing aids.
(a) Notwithstanding any provision of any policy, provision,
contract, plan, or agreement applicable to this article, any entity
regulated by this article shall, on or after July 1, 2013, provide
coverage for the cost of hearings aids that are prescribed by a
licensed physician for individuals covered under the policy or plan
who are under eighteen years of age. Coverage shall be as follows:
(1) Initial hearing aids and replacement hearing aids not
more frequently than every thirty-six months.
(2) New hearing aids when alterations to the existing hearing
aids cannot adequately meet the needs of the covered individual.
(3) Services, including audiometric testing, hearing aid
evaluations, fittings, and adjustments.
(b) For purposes of this section, "hearing aid" means any
wearable device or instrument or any combination thereof,
designated for, represented as or offered for sale for the purpose
of aiding, improving or compensating for defective or impaired
human hearing and shall include ear molds, parts, attachments or
other medically necessary accessories, but excluding batteries and
cords.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered individuals apply to hearing aids covered pursuant to this section. Required
coverage is further limited to the cost of one hearing aid
including all covered hearing aid-related services
not to exceed an
aggregate of $1,400 per hearing-impaired ear every thirty-six
months. The insured may choose a higher priced hearing aid and may
pay the difference in cost above the $1,400 limit as provided in
this section without any financial or contractual penalty to the
insured or to the provider of the hearing aid.
(d) To the extent that the provisions of this section require
benefits that exceed the essential health benefits specified under
section 1302(b) of the Patient Protection and Affordable Care Act,
Pub. L. No. 111-148, as amended, the specific benefits that exceed
the specified essential heath benefits shall not be required of a
health benefit plan when the plan is offered by a health care
insurer in this state.
ARTICLE 24. HOSPITAL MEDICAL AND DENTAL CORPORATIONS.
§33-24-7l. Required coverage for hearing aids.
(a) Notwithstanding any provision of any policy, provision,
contract, plan, or agreement applicable to this article, any entity
regulated by this article shall, on or after July 1, 2013, provide
coverage for the cost of hearing aids that are prescribed by a
licensed physician for individuals covered under the policy or plan
who are under eighteen years of age. Coverage shall be as follows:
(1) Initial hearing aids and replacement hearing aids not more frequently than every thirty-six months.
(2) New hearing aids when alterations to the existing hearing
aids cannot adequately meet the needs of the covered individual.
(3) Services, including audiometric testing, hearing aid
evaluations, fittings, and adjustments.
(b) For purposes of this section, "hearing aid" means any
wearable device or instrument or any combination thereof,
designated for, represented as or offered for sale for the purpose
of aiding, improving or compensating for defective or impaired
human hearing and shall include earmolds, parts, attachments or
other medically necessary accessories, but excluding batteries and
cords.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered individuals
apply to hearing aids covered pursuant to this section. Required
coverage is further limited to the cost of one hearing aid
including all covered hearing aid-related services
not to exceed an
aggregate of $1,400 per hearing-impaired ear every thirty-six
months. The insured may choose a higher priced hearing aid and may
pay the difference in cost above the $1,400 limit as provided in
this section without any financial or contractual penalty to the
insured or to the provider of the hearing aid.
(d) To the extent that the provisions of this section require benefits that exceed the essential health benefits specified under
section 1302(b) of the Patient Protection and Affordable Care Act,
Pub. L. No. 111-148, as amended, the specific benefits that exceed
the specified essential heath benefits shall not be required of a
health benefit plan when the plan is offered by a health care
insurer in this state.
ARTICLE 25. HEALTH CARE CORPORATION.
§33-25-8i. Required coverage for hearing aids.
(a) Notwithstanding any provision of any policy, provision,
contract, plan, or agreement applicable to this article, any entity
regulated by this article shall, on or after July 1, 2013, provide
coverage for the cost of hearing aids that are prescribed by a
licensed physician for individuals covered under the policy or plan
who are under eighteen years of age. Coverage shall be as follows:
(1) Initial hearing aids and replacement hearing aids not
more frequently than every thirty-six months.
(2) New hearing aids when alterations to the existing hearing
aids cannot adequately meet the needs of the covered individual.
(3) Services, including audiometric testing, hearing aid
evaluations, fittings, and adjustments.
(b) For purposes of this section, "hearing aid" means any
wearable device or instrument or any combination thereof,
designated for, represented as or offered for sale for the purpose
of aiding, improving or compensating for defective or impaired human hearing and shall include ear molds, parts, attachments or
other medically necessary accessories, but excluding batteries and
cords.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered individuals
apply to hearing aids covered pursuant to this section. Required
coverage is further limited to the cost of one hearing aid
including all covered hearing aid-related services
not to exceed an
aggregate of $1,400 per hearing-impaired ear every thirty-six
months. The insured may choose a higher priced hearing aid and may
pay the difference in cost above the $1,400 limit as provided in
this section without any financial or contractual penalty to the
insured or to the provider of the hearing aid.
(d) To the extent that the provisions of this section require
benefits that exceed the essential health benefits specified under
section 1302(b) of the Patient Protection and Affordable Care Act,
Pub. L. No. 111-148, as amended, the specific benefits that exceed
the specified essential heath benefits shall not be required of a
health benefit plan when the plan is offered by a health care
insurer in this state.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-8k. Required coverage for hearing aids.
(a) Notwithstanding any provision of any policy, provision, contract, plan, or agreement applicable to this article, any entity
regulated by this article shall, on or after July 1, 2013, provide
coverage for the cost of hearings aids that are prescribed by a
licensed physician for individuals covered under the policy or plan
who are under eighteen years of age. Coverage shall be as follows:
(1) Initial hearing aids and replacement hearing aids not more
frequently than every thirty-six months.
(2) New hearing aids when alterations to the existing hearing
aids cannot adequately meet the needs of the covered individual.
(3) Services, including audiometric testing, hearing aid
evaluations, fittings, and adjustments.
(b) For purposes of this section, "hearing aid" means any
wearable device or instrument or any combination thereof,
designated for, represented as or offered for sale for the purpose
of aiding, improving or compensating for defective or impaired
human hearing and shall include ear molds, parts, attachments or
other medically necessary accessories, but excluding batteries and
cords.
(c) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered individuals
apply to hearing aids covered pursuant to this section. Required
coverage is further limited to the cost of one hearing aid
including all covered hearing aid-related services
not to exceed an aggregate of $1,400 per hearing-impaired ear every thirty-six
months. The insured may choose a higher priced hearing aid and may
pay the difference in cost above the $1,400 limit as provided in
this section without any financial or contractual penalty to the
insured or to the provider of the hearing aid.
(d) To the extent that the provisions of this section require
benefits that exceed the essential health benefits specified under
section 1302(b) of the Patient Protection and Affordable Care Act,
Pub. L. No. 111-148, as amended, the specific benefits that exceed
the specified essential heath benefits shall not be required of a
health benefit plan when the plan is offered by a health care
insurer in this state.
NOTE: The purpose of this bill is to require health insurers
and PEIA to cover hearing aids for individuals under eighteen years
of age when prescribed by a licensed physician. Coverage is
limited as follows: (1)Initial hearing aids and replacement hearing
aids not more frequently than every thirty-six months; (2) hearing
aids when alterations to the existing hearing aids cannot
adequately meet the needs of the covered individual; and
(3)
services, including audiometric testing, the initial hearing aid
evaluation, fitting, and adjustments.
Covered individuals may have
to meet deductibles, coinsurance, or other limitations.
§5-16-7f
, §33-15-4k, §33-16-3w, §33-24-7l, §33-25-8i, and
§33-25A-8k are new; therefore, strike-throughs and underscoring
have been omitted.