HB 79 — Insurance Coverage for Hearing Aids for Children

F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB79CS/HB79 2022 A bill to be entitled An act relating to insurance coverage for hearing aids for children;

providingdefining a definition of the term "hearing aid";

requiring certain individual health insurance policies to provide coverage for hearing aids for certain children 2118 years of age or younger under certain circumstances;

specifying healthcertain carecoverage providersrequirements; who may prescribe, fit, and dispense the hearing aids;

specifyingproviding aan minimumexception coverageto limitthe withinrequirements; a certain timeframe;

providing an exception;

requiring certain individual health maintenance contracts to provide coverage for hearing aids for certain children 2118 years of age or younger under certain circumstances;

specifying healthcertain carecoverage providersrequirements; who may prescribe, fit, and dispense the hearing aids;

specifyingproviding aan minimumexception coverageto limitthe withinrequirements; a certain timeframe;

providing an exception;

providingdefining a definition of the term "hearing aid";

PageBe 1ofIt 4Enacted CODING:by the Legislature of the State of Florida:

Section 1.

627.6413, Florida Statutes, is created to read:

627.6413 Coverage for hearing aids for children.— Page 1of 4 CODING:

hb0079-00hb0079-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB79CS/HB79 2022 Be(1) ItAs Enactedused byin this section, the Legislatureterm of"hearing aid" means any wearable instrument or device designed for, offered for the Statepurpose ofof, Florida:or represented as aiding persons with or compensating for impaired hearing, and includes ear molds.

SectionThe 1.term does not include a cochlear implant.

Section(2) 627.6413,A Floridahealth Statutes,insurer issuing an individual policy that provides major medical or similar comprehensive coverage for a dependent child of the insured must provide coverage for a hearing aid for any such child 18 years of age or younger diagnosed with hearing loss by a physician licensed under chapter 458 or chapter 459 or by an audiologist licensed under part I of chapter 468 and for whom the hearing aid is createdprescribed toas read:medically necessary.

627.6413 Coverage for a hearing aidsaid forprescribed children.—to (1)a Aschild used18 inyears thisof section,age theor termyounger "hearingmust aid"require meansthe anyhearing wearableaid instrumentto orbe deviceprescribed, designedfitted, for,and offereddispensed forby thea purposephysician of,licensed orunder representedchapter as458 aidingor personschapter with459 or compensatingan for,audiologist impairedlicensed hearing.under part I of chapter 468.

(2)(3) AThe health insurer issuing an individual policy that provides major medical or similar comprehensive coverage to an insured or a family member of an insured must provide coveragebenefits forin aany hearing24-month aidperiod for an insured child 21 years of ageat orleast younger$3,500 whoper isear. diagnosed with hearing loss by a licensed physician or a licensed audiologist and for whom the hearing aid is prescribed as medically necessary.

CoverageThe forpolicy amay hearinglimit aidcoverage prescribedfor toear amolds child younger than 18 years of age must require the hearing aid to besix prescribed,ear fitted,molds andin dispensedany by24-month aperiod. licensed physician or a licensed audiologist.

CoverageHowever, forif a hearingchild aidexperiences prescribeda tosignificant aand childunexpected betweenchange 18in andhis 21or yearsher ofhearing age,or inclusive,a mustmedical requirecondition requiring an unexpected change in the prescription for the hearing aid tobefore bethe fittedexisting 24-month period expires and dispensedalterations byto athe licensedexisting physician,hearing aaid licenseddo audiologist,not or acannot licensedmeet hearingthe aidneeds specialist.of the Page 2of 4 CODING:

(3) The policy must provide a minimum coverage limit of $3,500 per ear within a 24-month period.

However, if a child Page 2of 4 CODING:

hb0079-00hb0079-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB79CS/HB79 2022 experiences a significant and unexpected change in his or her hearing or a medical condition requiring an unexpected change in the hearing aid before the existing 24-month period expires, and if alterations to the existing hearing aid do not or cannot meet the needs of the child, a new 24-month period must begin with full benefits and coverage.

641.31 Health maintenance contracts.— (48)(a) A health maintenance organization issuing an individual contract that provides major medical or similar comprehensive coverage tofor a subscriberdependent orchild a family member of athe subscriber must provide coverage for a hearing aid for aany coveredsuch child 2118 years of age or younger who is diagnosed with hearing loss by a physician licensed physicianunder chapter 458 or achapter licensed459 or by an audiologist licensed under part I of chapter 468 and for whom the hearing aid is prescribed as medically necessary.

Coverage for a hearing aid prescribed to a child younger than 18 years of age or younger must require the hearing aid to be prescribed, fitted, and dispensed by a physician licensed physicianunder chapter 458 or achapter 459 or an audiologist licensed audiologist.under part I of chapter 468.

Coverage(b) forThe acontract hearingmust aidprovide prescribedbenefits toin aany child24-month Pageperiod 3ofof 4at CODING:least $3,500 per ear.

The contract may limit Page 3of 4 CODING:

hb0079-00hb0079-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB79CS/HB79 2022 betweencoverage 18for andear 21molds years of age, inclusive, must require the hearing aid to besix fittedear andmolds dispensedin byany a24-month licensedperiod. physician, a licensed audiologist, or a licensed hearing aid specialist.

(b)However, Theif contracta mustchild provideexperiences a minimumsignificant coverageand limitunexpected ofchange $3,500in perhis earor withinher hearing or a medical condition requiring an unexpected change in the prescription for the hearing aid before the existing 24-month period.period expires and alterations to the existing hearing aid do not or cannot meet the needs of the child, a new 24-month period must begin with full benefits and coverage.

However, if a child experiences a significant and unexpected change in his or her hearing or a medical condition requiring an unexpected change in the hearing aid before the existing 24-month period expires, and if alterations to the existing hearing aid do not or cannot meet the needs of the child, a new 24-month period must begin with full benefits and coverage.

(d) As used in this subsection,section, the term "hearing aid" means any wearable instrument or device designed for, offered for the purpose of, or represented as aiding persons with or compensating for impaired hearing.hearing, and includes ear molds.

The term does not include a cochlear implant.

hb0079-00hb0079-01-c1