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.