Bill Text: CA SB635 | 2023-2024 | Regular Session | Enrolled
Bill Title: Health care coverage: hearing aids.
Spectrum: Moderate Partisan Bill (Democrat 16-2)
Status: (Vetoed) 2024-01-25 - Veto sustained. [SB635 Detail]
Download: California-2023-SB635-Enrolled.html
|
Enrolled
September 19, 2023 |
|
Passed
IN
Senate
September 14, 2023 |
|
Passed
IN
Assembly
September 11, 2023 |
|
Amended
IN
Assembly
September 08, 2023 |
|
Amended
IN
Assembly
July 13, 2023 |
|
Amended
IN
Assembly
June 08, 2023 |
|
Amended
IN
Senate
May 18, 2023 |
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Senate Bill
No. 635
| Introduced by Senators Menjivar and Portantino (Principal coauthor: Assembly Member Arambula) (Coauthors: Senators Allen, Ashby, Becker, Dahle, Min, Rubio, and Wahab) (Coauthors: Assembly Members Aguiar-Curry, Gallagher, Maienschein, Ortega, Pacheco, Weber, Wilson, and Wood) |
February 16, 2023 |
An act to add Section 1367.72 to the Health and Safety Code, and to add Section 10123.72 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 635, Menjivar.
Health care coverage: hearing aids.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law sets forth specified coverage requirements for health care service plan contracts and health insurance policies.
This bill, the Let California Kids Hear Act, would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2025, to include coverage for
hearing aids for enrollees and insureds under 21 years of age, if medically necessary. The bill would limit the maximum required coverage amount to $3,000 per individual hearing aid, as specified. Because a willful violation of the bill’s requirements relative to a health care service plan would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
This act shall be known, and may be cited, as the Let California Kids Hear Act.SEC. 2.
Section 1367.72 is added to the Health and Safety Code, to read:1367.72.
(a) A health care service plan contract issued, amended, or renewed on or after January 1, 2025, shall include coverage for hearing aids for all enrollees under 21 years of age, if medically necessary. The covered service shall be provided by a contracted provider, unless the contract allows for out-of-network coverage. For children under five years of age, a contracted provider shall include a pediatric audiologist.(b) The maximum required coverage amount under this section is three thousand dollars ($3,000) per individual hearing aid. An enrollee may choose to purchase a hearing aid that exceeds the maximum coverage amount and shall be responsible for the difference
between the cost of the hearing aid and the maximum coverage amount.
(1) Hearing aids covered pursuant to this section shall not be subject to a deductible, coinsurance, or copayment requirement. Coverage of hearing aids under this section shall not be subject to financial or treatment limitations, including a dollar limit that is set below three thousand dollars ($3,000) per individual hearing aid.
(2) If a contract is a “high deductible health plan” under the definition set forth in Section 223(c)(2) of Title 26 of the United States Code, the contract shall not impose cost sharing as specified above, unless not applying cost sharing would conflict with federal requirements for high deductible health plans.
(3) Coverage for hearing aids shall include an initial assessment, new hearing aids at least once every four years, new earmolds, new hearing
aids if alterations to existing hearing aids cannot meet the needs of the enrollee, a new hearing aid if the existing one is no longer working, and fittings, adjustments, auditory training, and maintenance of the hearing aids. The new hearing aid limit shall not apply if alterations to existing hearing aids cannot meet the needs of the enrollee or an existing hearing aid is no longer working.
(c) For purposes of this section, “hearing aid” means an electronic device designed to aid or compensate for impaired human hearing and any parts, attachments, or accessories, including earmolds, but excluding batteries and cords. This includes both hearing aids traditionally worn behind the ear and nonimplanted auditory osseointegrated devices.
(d) (1) This section does not apply to a Medicare supplement policy or specialized health care service plan contract that covers only dental or vision benefits.
(2) This section shall not apply to Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, and Chapter
8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code. For these plans, the Medi-Cal requirements imposed pursuant to subdivision (l) of Section 14132 of the Welfare and Institutions Code shall apply.
(e) Services described in this section shall be covered by a nongrandfathered health care service plan contract in the individual and small group market only to the extent that there is an appropriation to cover the cost of the services for plans offered through the Exchange, if it is determined that federal law requires the state to defray the costs of the benefits.
SEC. 3.
Section 10123.72 is added to the Insurance Code, to read:10123.72.
(a) A health insurance policy issued, amended, or renewed on or after January 1, 2025, shall include coverage for hearing aids for all insureds under 21 years of age, if medically necessary. The covered service shall be provided by a contracted provider, unless the policy allows for out-of-network coverage. For children under five years of age, a contracted provider shall include a pediatric audiologist.(b) The maximum required coverage amount under this section is three thousand dollars ($3,000) per individual hearing aid. An insured may choose to purchase a hearing aid that exceeds the maximum coverage amount and shall be responsible for the difference
between the cost of the hearing aid and the maximum coverage amount.
(1) Hearing aids covered pursuant to this section shall not be subject to a deductible, coinsurance, or copayment requirement. Coverage of hearing aids under this section shall not be subject to financial or treatment limitations, including a dollar limit that is set below three thousand dollars ($3,000) per individual hearing aid.
(2) If a health insurance policy is a “high deductible health plan” under the definition set forth in Section 223(c)(2) of Title 26 of the United States Code, the policy shall not impose cost sharing as specified above, unless not applying cost sharing would conflict with federal requirements for high deductible health plans.
(3) Coverage for hearing aids shall include an initial assessment, new hearing aids at least once every four years, new earmolds, new hearing
aids if alterations to existing hearing aids cannot meet the needs of the insured, a new hearing aid if the existing one is no longer working, and fittings, adjustments, auditory training, and maintenance of the hearing aids. The new hearing aid limit shall not apply if alterations to existing hearing aids cannot meet the needs of the insured or an existing hearing aid is no longer working.
(c) For purposes of this section, “hearing aid” means an electronic device designed to aid or compensate for impaired human hearing and any parts, attachments, or accessories, including earmolds, but excluding batteries and cords. This includes both hearing aids traditionally worn behind the ear and nonimplanted auditory osseointegrated devices.
(d) (1) This section does not apply to a specialized health insurance policy that covers only dental or vision benefits or a Medicare supplemental policy.
(2) This section shall not apply to Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section
14000) of, and Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code. For these plans, the Medi-Cal requirements imposed pursuant to subdivision (l) of Section 14132 of the Welfare and Institutions Code shall apply.
(e) Services described in this section shall be covered by a nongrandfathered health care service plan contract in the individual and small group market only to the extent that there is an appropriation to cover the cost of the services for plans offered through the Exchange, if it is determined that federal law requires the state to defray the costs of the benefits.
