Florida Senate - 2022 SB 498 By Senator Baxley 12-00760-22 2022498__ 1 A bill to be entitled 2 An act relating to insurance coverage for hearing aids 3 for children; creating s. 627.6413, F.S.; providing a 4 definition of the term “hearing aid”; requiring 5 certain individual health insurance policies to 6 provide coverage for hearing aids for children 21 7 years of age or younger under certain circumstances; 8 specifying health care providers who may prescribe, 9 fit, and dispense the hearing aids; specifying a 10 minimum coverage limit within a certain timeframe; 11 providing an exception; providing that an insured is 12 responsible for certain costs that exceed the policy 13 limit; providing applicability; amending s. 641.31, 14 F.S.; requiring certain individual health maintenance 15 contracts to provide coverage for hearing aids for 16 children 21 years of age or younger under certain 17 circumstances; specifying health care providers who 18 may prescribe, fit, and dispense the hearing aids; 19 specifying a minimum coverage limit within a certain 20 timeframe; providing an exception; providing that a 21 subscriber is responsible for certain costs that 22 exceed the contract limit; providing a definition of 23 the term “hearing aid”; providing applicability; 24 providing an effective 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. 35 (2) A health insurer issuing an individual policy that 36 provides major medical or similar comprehensive coverage to an 37 insured or a family member of an insured must provide coverage 38 for a hearing aid for an insured child 21 years of age or 39 younger who is diagnosed with hearing loss by a licensed 40 physician or a licensed audiologist and for whom the hearing aid 41 is prescribed as medically necessary. Coverage for a hearing aid 42 prescribed to a child younger than 18 years of age must require 43 the hearing aid to be prescribed, fitted, and dispensed by a 44 licensed physician or a licensed audiologist. Coverage for a 45 hearing aid prescribed to a child between 18 and 21 years of 46 age, inclusive, must require the hearing aid to be fitted and 47 dispensed by a licensed physician, a licensed audiologist, or a 48 licensed hearing aid specialist. 49 (3) The policy must provide a minimum coverage limit of 50 $3,500 per ear within a 24-month period. However, if a child 51 experiences a significant and unexpected change in his or her 52 hearing or a medical condition requiring an unexpected change in 53 the hearing aid before the existing 24-month period expires, and 54 if alterations to the existing hearing aid do not or cannot meet 55 the needs of the child, a new 24-month period must begin with 56 full benefits and coverage. 57 (4) An insured is responsible for the cost of hearing aids 58 and related services which exceeds the coverage limit provided 59 by his or her policy. 60 (5) This section applies to a policy issued or renewed on 61 or after January 1, 2023. 62 Section 2. Subsection (48) is added to section 641.31, 63 Florida Statutes, to read: 64 641.31 Health maintenance contracts.— 65 (48)(a) A health maintenance organization issuing an 66 individual contract that provides major medical or similar 67 comprehensive coverage to a subscriber or a family member of a 68 subscriber must provide coverage for a hearing aid for a covered 69 child 21 years of age or younger who is diagnosed with hearing 70 loss by a licensed physician or a licensed audiologist and for 71 whom the hearing aid is prescribed as medically necessary. 72 Coverage for a hearing aid prescribed to a child younger than 18 73 years of age must require the hearing aid to be prescribed, 74 fitted, and dispensed by a licensed physician or a licensed 75 audiologist. Coverage for a hearing aid prescribed to a child 76 between 18 and 21 years of age, inclusive, must require the 77 hearing aid to be fitted and dispensed by a licensed physician, 78 a licensed audiologist, or a licensed hearing aid specialist. 79 (b) The contract must provide a minimum coverage limit of 80 $3,500 per ear within a 24-month period. However, if a child 81 experiences a significant and unexpected change in his or her 82 hearing or a medical condition requiring an unexpected change in 83 the hearing aid before the existing 24-month period expires, and 84 if alterations to the existing hearing aid do not or cannot meet 85 the needs of the child, a new 24-month period must begin with 86 full benefits and coverage. 87 (c) A subscriber is responsible for the cost of hearing 88 aids and related services which exceeds the coverage limit 89 provided by his or her contract. 90 (d) As used in this subsection, the term “hearing aid” 91 means any wearable instrument or device designed for, offered 92 for the purpose of, or represented as aiding persons with or 93 compensating for impaired hearing. 94 (e) This subsection applies to a contract issued or renewed 95 on or after January 1, 2023. 96 Section 3. This act shall take effect January 1, 2023.