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TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-48 SO AS TO PROVIDE DEFINITIONS, TO REQUIRE ALL HEALTH INSURANCE AND GROUP HEALTH BENEFIT PLANS TO COVER HEARING AIDS AND REPLACEMENT HEARING AIDS FOR INSUREDS WITH IMPAIRED HEARING, AND TO PROVIDE FOR THE SCOPE OF COVERAGE, AMONG OTHER THINGS.
Whereas, hearing loss is the third most common health problem in the United States, with nearly thirty-six million Americans now reporting lost hearing; and
Whereas, hearing loss affects a person's quality of life by impairing communication, having ramifications on the ability of a person to learn, work, and enjoy relationships and activities; and
Whereas, hearing aids are critical to enabling people with hearing loss to enjoy the same quality of life as others who have not experienced hearing loss to the same degree, and are particularly critical to the language development of children with hearing loss because the earlier in age hearing loss is identified and intervention begun, the more likely it is that the delays in speech and language development will be diminished; and
Whereas, children who do not receive early intervention, including hearing amplification, cost schools hundreds of thousands of dollars each during their schooling and are faced with overall lifetime costs reaching into the millions of dollars in special education service costs, lost wages, and compounding health complications; and
Whereas, the high cost of hearing aids often prevents South Carolinians suffering from hearing loss from enjoying the critical benefits of having hearing aids, with the financial hardship being greatest for those families above the federal poverty levels that do not qualify for state assistance and who do not have insurance coverage for hearing aids; and
Whereas, widespread availability of hearing aid insurance coverage not only will minimize the impact of hearing loss in general, but it also will help bridge the gap between early identification and diagnosis of hearing loss through the universal newborn hearing screening by increasing accessibility to amplification devices that can correct the deficiency; and
Whereas, states that require hearing aid coverage in health insurance plans help increase the accessibility and affordability of essential hearing health care for its citizens who suffer from hearing loss. Now, therefore,
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Article 1, Chapter 71, Title 38 of the 1976 Code is amended by adding:
"Section 38-71-48. (A) As used in this section:
(1) 'Hearing loss' means any degree of permanent impairment of the ability to apprehend sound.
(2) 'Hearing aid' means any nonexperimental and wearable instrument or device designed for the ear and offered to aid or compensate for impaired human hearing, including any parts, ear molds, repair parts, and replacement parts of this instrument or device. 'Hearing aid' excludes batteries, cords, and other assistive listening devices.
(3) 'Audiologist' means an individual licensed to practice audiology in this State pursuant to Chapter 67, Title 40.
(4) 'Audiologic evaluation' means an evaluation consisting of procedures to:
(a) assess the status of the auditory system, the site of an auditory disorder, the type and degree of hearing loss, and the potential effects of hearing loss on communication; and
(b) identify appropriate treatment and referral options. Referral options for evaluation should include linkage to state Part C Individuals with Disabilities Education Act coordinating agencies or other appropriate agencies or medical entities.
(5) 'Auditory habilitation' means intervention including the use of procedures, techniques, and technologies to facilitate the receptive and expressive communication abilities of a child with hearing loss.
(6) 'Insurer' means an insurance company, a health maintenance organization, and other entity that provides health insurance coverage as defined in Section 38-71-670(6), is licensed to engage in the business of insurance in this State, and is subject to state insurance regulation.
(7) 'Health maintenance organization' means an organization as defined in Section 38-33-20(8).
(8) 'Health insurance plan' means a group health insurance policy or group health benefit plan offered by an insurer, including the State Health Plan.
(9) 'State Health Plan' means the employee and retiree insurance program provided in Article 5, Chapter 11, Title 1.
(10) 'Practice of fitting, dispensing, servicing, and sale of hearing instruments' means the measurement of human hearing with an audiometer for the purpose of making selections, recommendations, adoptions, services, and sales of hearing instruments, including the making of ear molds, as a part of the hearing instrument. An audiometer used in this section must be calibrated to the current American National Standard Institute standards.
(B) A health insurance plan must provide to all insureds coverage for hearing aids and replacement hearing aids for a covered individual with impaired hearing. This coverage must include fitting, dispensing, servicing, and repairs, including providing ear molds as necessary to maintain optimal fit, and prescribed and dispensed by the treating licensed audiologist of the insured. A health insurance plan may not deny or refuse coverage on, refuse to contract with, or refuse to renew or refuse to reissue or otherwise terminate or restrict coverage on a covered individual solely because he is or has been previously diagnosed with hearing loss.
(C) A covered individual must be diagnosed with permanent hearing loss by a licensed audiologist to be eligible for coverage under this section.
(D) Coverage for an initial hearing aid and a replacement is subject to a one thousand five-hundred-dollar minimum amount and up to a two thousand five-hundred-dollar maximum amount for a hearing impaired ear benefit in a thirty-six month period. The insured may choose a hearing aid exceeding the coverage amount of the insured but must pay the difference in cost above the amount of coverage required by this section.
(E) A health insurance plan shall provide a new hearing aid when alterations to the existing hearing aid cannot adequately meet the needs of the covered individual as determined by the treating licensed audiologist.
(F) A health insurance plan may not impose a financial or contractual penalty to an insured or to the audiologist providing the hearing aid if a covered individual elects to purchase a hearing aid priced higher than the benefit amount by paying the difference between the benefit amount and the price of the hearing aid.
(G) Coverage required pursuant to subsection (B):
(1) may not be subject to dollar limits, deductibles, and coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, and coinsurance provisions that apply to physical illness generally under the health insurance plan, except as otherwise provided in subsection (E); and
(2) may be subject to other general exclusions and limitations of the health insurance plan, including, but not limited to, coordination of benefits, participating provider requirements, restrictions on services provided by family or household members, review of health care services including review of medical necessity, case management, and other managed care provisions."
SECTION 2. This act takes effect July 1, 2016, and applies to health insurance plans issued, renewed, delivered, or entered into on or after the effective date of this act.
This web page was last updated on February 25, 2016 at 1:19 PM