Iowa-2021-SF2121-Introduced

S.F. 2121 Section 1. NEW SECTION . 514C.36 Hearing aid coverage for 1 covered persons age eighteen and younger. 2 1. Definitions. For the purposes of this section: 3 a. “Audiologist” means a person who engages in the practice 4 of audiology and is licensed in this state pursuant to chapter 5 154F. 6 b. “Cost-sharing” means any coverage limit, copayment, 7 coinsurance, deductible, or other out-of-pocket expense 8 required by a health carrier. 9 c. “Covered person” means the same as defined in section 10 514J.102. 11 d. “Health care professional” means the same as defined in 12 section 514J.102. 13 e. “Health care services” means the same as defined in 14 section 514J.102. 15 f. “Health carrier” means the same as defined in section 16 514J.102. 17 g. “Hearing aid” means the same as defined in section 18 154A.1. 19 h. “Hearing aid fitting” means the same as defined in 20 section 154A.1. 21 i. “Hearing aid specialist” means the same as defined in 22 section 154A.1. 23 j. “Practice of audiology” means the same as defined in 24 section 154F.1. 25 2. Required coverage. 26 a. Notwithstanding the uniformity of treatment requirements 27 of section 514C.6, a health carrier that offers individual, 28 group, or small group contracts, policies, or plans in this 29 state that provide for third-party payment or prepayment of 30 health or medical expenses shall offer coverage for the cost 31 of a hearing aid as recommended by a health care professional 32 or audiologist for a covered person who is age eighteen or 33 younger. 34 b. Coverage required under this section shall include all 35 -1- LSB 5171XS (1) 89 ko/rn 1/ 4

S.F. 2121 of the following: 1 (1) Hearing aid fitting and dispensing services conducted 2 by a hearing aid specialist, audiologist, or health care 3 professional. 4 (2) The provision of ear molds as necessary to maintain 5 optimal fit of hearing aids. 6 (3) Any health care services related to a hearing 7 aid, including audiological habilitation or audiological 8 rehabilitation, as recommended by a health care professional 9 or audiologist. 10 c. Coverage required under this section is limited to one 11 hearing aid for each ear during each consecutive three-year 12 period for a covered person who is age eighteen or younger. 13 d. Coverage required under this section shall not be less 14 favorable than coverage a health carrier offers for general 15 physical illness. 16 e. Cost-sharing requirements imposed for coverage 17 required under this section shall not be less favorable than 18 cost-sharing requirements imposed by a health carrier for 19 general physical illness. 20 3. Rules. The commissioner shall adopt rules pursuant to 21 chapter 17A to administer this section. 22 4. Applicability. 23 a. This section shall apply to the following classes of 24 third-party payment provider contracts, policies, or plans 25 delivered, issued for delivery, continued, or renewed in this 26 state on or after January 1, 2023: 27 (1) Individual or group accident and sickness insurance 28 providing coverage on an expense-incurred basis. 29 (2) An individual or group hospital or medical service 30 contract issued pursuant to chapter 509, 514, or 514A. 31 (3) An individual or group health maintenance organization 32 contract regulated under chapter 514B. 33 (4) A plan established for public employees pursuant to 34 chapter 509A. 35 -2- LSB 5171XS (1) 89 ko/rn 2/ 4

S.F. 2121 b. This section shall not apply to accident-only, 1 specified disease, short-term hospital or medical, hospital 2 confinement indemnity, credit, dental, vision, Medicare 3 supplement, long-term care, basic hospital and medical-surgical 4 expense coverage as defined by the commissioner, disability 5 income insurance coverage, coverage issued as a supplement 6 to liability insurance, workers’ compensation or similar 7 insurance, or automobile medical payment insurance. 8 EXPLANATION 9 The inclusion of this explanation does not constitute agreement with 10 the explanation’s substance by the members of the general assembly. 11 This bill requires a health carrier (carrier) that offers 12 individual, group, or small group contracts, policies, or 13 plans in this state that provide for third-party payment or 14 prepayment of health or medical expenses to offer coverage 15 for hearing aids for covered persons age 18 and younger as 16 recommended by a health care professional or audiologist. 17 The bill requires the coverage to include hearing aid 18 fitting and dispensing services conducted by a hearing aid 19 specialist, audiologist, or health care professional. The 20 coverage must include ear molds as necessary to maintain 21 optimal hearing aid fit and any health care services related 22 to a hearing aid, including audiological habilitation or 23 audiological rehabilitation, as recommended by a health care 24 professional or audiologist. 25 The bill limits coverage to one hearing aid for each ear 26 during each consecutive three-year period for a covered person 27 age 18 or younger. 28 The bill requires that coverage cannot be less favorable 29 than coverage a carrier offers for general physical illness 30 and a carrier is prohibited from imposing less favorable 31 cost-sharing requirements than those imposed for general 32 physical illnesses. 33 The commissioner of insurance is required to adopt rules to 34 administer the bill. 35 -3- LSB 5171XS (1) 89 ko/rn 3/ 4

S.F. 2121 The bill applies to third-party payment provider contracts, 1 policies, or plans delivered, issued for delivery, continued, 2 or renewed in this state on or after January 1, 2023, by the 3 third-party payment providers enumerated in the bill. The bill 4 specifies the types of specialized health-related insurance 5 which are not subject to the coverage requirements. 6 -4- LSB 5171XS (1) 89 ko/rn 4/ 4