The legislative session started in January and the bill that would require hearing aids and cochlear implants to be covered by group and individual insurance plans in Wisconsin.
Thanks to many legislators, especially Senator Lassa and her staff Jessica Kelly, the bill is back and is better than ever! The bills this year are different than last session. We are excited to say that the bills are much stronger. In many instances, the language is streamlined and concepts are defined clearly so as to avoid confusion after the bill becomes law. Some of the substantive changes include:
1) coverage of children up through the age of 18 years old;
2) coverage of treatment including services, diagnosis, procedures, surgery and therapy;
3) defines "cochlear implants" to include all implantable devices; and
4) removes language from the bill last session that would have required families to pay back the cost of hearing aids and cochlear implants if they voluntarily left the insurance company before a years time.
The links to the bills are:
The Senate version of the bill (SB 27) has been directed to the Committee on Health, Health Insurance, Privacy, Property Tax Relief, and Revenue. The committee is headed by Erpanbach, and also includes Carpenter, Robson, Lassa, Lazich, Kanavas, and Darling.
The Assembly Bill (AB 16) has been directed to the Committee on Insurance headed by Cullen. Also represented on the committee are Molepski, Ziegelbauer, Parisi, Berceau, Hebl, Nygren, Suder, Vos and Roth.
Below is a summary of the bill written by the Legislative Reference Bureau:
This bill requires health insurance policies and plans to cover the cost of hearing aids, which include any externally wearable instruments or devices designed to enhance hearing, and cochlear implants, which include any implantable instruments or devices designed to enhance hearing, that are prescribed by a physician or audiologist in accordance with accepted professional medical or audiological standards, for any child under 18 years of age who has coverage under the policy or plan and who is certified as deaf or hearing impaired by a physician or an audiologist. Treatment (defined as services, diagnoses, procedures, surgery, and therapy provided by a health care professional) for such a child that is related to hearing aids and cochlear implants is also required to be covered. Coverage for hearing aids is not required to exceed the cost of one hearing aid per ear per child more often than once every three years. The coverage requirement applies to both individual and group health insurance policies and plans, including defined network plans and cooperative sickness care associations; to health care plans offered by the state to its employees, including a self−insured plan; and to self−insured health plans of counties, cities, towns, villages, and school districts. The requirement specifically does not apply to limited−scope benefit plans, medicare replacement or supplement policies, long−term care policies, or policies covering only certain specified diseases. The required coverage may be subject to any limitations, cost−sharing provisions, or exclusions, other than a preexisting condition exclusion, that apply generally under the policy or plan. An exception is that an individual health insurance policy may impose a preexisting condition exclusion that does not exceed one year with respect to coverage for cochlear implants and related treatment. However, the bill requires an individual health insurance policy that imposes a preexisting condition exclusion to cover the cost of cochlear implants and related treatment during the preexisting condition exclusion period if certain specified medical conditions occur during the period that make time of the essence for a child to receive the implants and related treatment.
For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.
