Florida Senate - 2021 SB 1268
By Senator Baxley
12-00744B-21 20211268__
1 A bill to be entitled
2 An act relating to coverage for hearing aids for
3 children; creating s. 627.6413, F.S.; defining the
4 term “hearing aid”; requiring certain individual
5 health insurance policies to provide coverage for
6 hearing aids for children 18 years of age or younger,
7 under certain circumstances; requiring the hearing
8 aids to be prescribed, fitted, and dispensed by
9 specified health care providers; specifying certain
10 coverage requirements; providing an exception;
11 providing that an insured is responsible for certain
12 costs that exceed the policy limit; providing
13 applicability; amending s. 641.31, F.S.; requiring
14 certain individual health maintenance organization
15 contracts to provide coverage for hearing aids for
16 children 18 years of age or younger, under certain
17 circumstances; requiring the hearing aids to be
18 prescribed, fitted, and dispensed by specified health
19 care providers; specifying certain coverage
20 requirements; providing an exception; providing that a
21 subscriber is responsible for certain costs that
22 exceed the contract limit; defining the term “hearing
23 aid”; providing applicability; providing an effective
24 date.
25
26 Be It Enacted by the Legislature of the State of Florida:
27
28 Section 1. Section 627.6413, Florida Statutes, is created
29 to read:
30 627.6413 Coverage for hearing aids for children.—
31 (1) As used in this section, the term “hearing aid” means
32 any wearable instrument or device designed for, offered for the
33 purpose of, or represented as aiding persons with or
34 compensating for impaired hearing, and includes ear molds. The
35 term does not include a cochlear implant.
36 (2) A health insurer issuing an individual policy that
37 provides major medical or similar comprehensive coverage for a
38 dependent child of the insured must provide coverage for a
39 hearing aid for any such child 18 years of age or younger who is
40 diagnosed with hearing loss by a physician licensed under
41 chapter 458 or chapter 459 or an audiologist licensed under part
42 I of chapter 468, and for whom the hearing aid is prescribed as
43 medically necessary. Coverage for a hearing aid prescribed to a
44 child 18 years of age or younger must require the hearing aid to
45 be prescribed, fitted, and dispensed by a physician licensed
46 under chapter 458 or chapter 459 or an audiologist licensed
47 under part I of chapter 468.
48 (3) The policy must provide benefits in any 24-month period
49 of at least $3,500 per ear. The policy may limit coverage for
50 ear molds to six ear molds in any 24-month period. However, if a
51 child experiences a significant and unexpected change in his or
52 her hearing or a medical condition requiring an unexpected
53 change in the prescription for the hearing aid before the
54 existing 24-month period expires, and alterations to the
55 existing hearing aid do not or cannot meet the needs of the
56 child, a new 24-month period must begin with full benefits and
57 coverage.
58 (4) An insured is responsible for the cost of hearing aids
59 and related services which exceeds the coverage limit provided
60 by his or her policy.
61 (5) This section applies to a policy that is issued or
62 renewed on or after January 1, 2022.
63 Section 2. Subsection (48) is added to section 641.31,
64 Florida Statutes, to read:
65 641.31 Health maintenance contracts.—
66 (48)(a) A health maintenance organization issuing an
67 individual contract that provides major medical or similar
68 comprehensive coverage for a dependent child of the insured must
69 provide coverage for a hearing aid for any such child 18 years
70 of age or younger who is diagnosed with hearing loss by a
71 physician licensed under chapter 458 or chapter 459 or an
72 audiologist licensed under part I of chapter 468, and for whom
73 the hearing aid is prescribed as medically necessary. Coverage
74 for a hearing aid prescribed to a child 18 years of age or
75 younger must require the hearing aid to be prescribed, fitted,
76 and dispensed by a physician licensed under chapter 458 or
77 chapter 459 or an audiologist licensed under part I of chapter
78 468.
79 (b) The contract must provide benefits in any 24-month
80 period of at least $3,500 per ear. The policy may limit coverage
81 for ear molds to six ear molds in any 24-month period. However,
82 if a child experiences a significant and unexpected change in
83 his or her hearing or a medical condition requiring an
84 unexpected change in the prescription for the hearing aid before
85 the existing 24-month period expires, and alterations to the
86 existing hearing aid do not or cannot meet the needs of the
87 child, a new 24-month period must begin with full benefits and
88 coverage.
89 (c) A subscriber is responsible for the cost of hearing
90 aids and related services which exceeds the coverage limit
91 provided by his or her contract.
92 (d) As used in this section, the term “hearing aid” means
93 any wearable instrument or device designed for, offered for the
94 purpose of, or represented as aiding persons with or
95 compensating for impaired hearing, and includes ear molds. The
96 term does not include a cochlear implant.
97 (e) This subsection applies to a contract that is issued or
98 renewed on or after January 1, 2022.
99 Section 3. This act shall take effect January 1, 2022.