Sec. 356z.30. Coverage for hearing aids.

378 words·~2 min read·/il/chapter-215/act-5/356z-30

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)As used in this Section:

"Hearing care professional" means a person who is a licensed hearing instrument dispenser, licensed audiologist, or licensed physician.

"Hearing instrument" or "hearing aid" means any wearable non-disposable, non-experimental instrument or device designed to aid or compensate for impaired human hearing and any parts, attachments, or accessories for the instrument or device, including an ear mold but excluding batteries and cords.

(b)An individual or group policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 103rd General Assembly must provide coverage for medically necessary hearing instruments and related services for all individuals when a hearing care professional prescribes a hearing instrument to augment communication.

(c)An insurer shall provide coverage, subject to all applicable co-payments, co-insurance, deductibles, and out-of-pocket limits, subject to the following restrictions:

(1)one hearing instrument shall be covered for each ear every 36 months;

(2)related services, such as audiological exams and selection, fitting, and adjustment

of ear molds to maintain optimal fit shall be covered when deemed medically necessary by a hearing care professional; and

(3)hearing instrument repairs may be covered when deemed medically necessary.

(d)If, at any time before or after the effective date of this amendatory Act of the 103rd General Assembly, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register, publishes a comment in the Federal Register, or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Pub. L. 111–148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of coverage for medically necessary hearing instruments and related services for any individual, then this Section is inoperative with respect to all such coverage other than that authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of coverage for medically necessary hearing instruments and related services for any individual subject to federally defrayed cost of coverage.