S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5495
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                                May 3, 2019
                                ___________
 
 Introduced  by Sens. PERSAUD, SKOUFIS -- read twice and ordered printed,
   and when printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law, in relation to the mandatory coverage
   of hearing aids by insurers and other organizations
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
 amended by adding a new paragraph 36 to read as follows:
   (36) (A) AS USED IN THIS PARAGRAPH, "HEARING AID" SHALL  MEAN  A  NON-
 DISPOSABLE DEVICE THAT IS OF A DESIGN AND CIRCUITRY TO OPTIMIZE AUDITION
 AND  LISTENING  SKILLS  IN THE ENVIRONMENT COMMONLY EXPERIENCED BY CHIL-
 DREN.
   (B) THIS PARAGRAPH SHALL APPLY TO THE FOLLOWING ENTITIES:
   (I) INSURERS AND NONPROFIT HEALTH SERVICE PLANS, INCLUDING THE  OFFICE
 OF  GROUP BENEFITS, THAT PROVIDE HOSPITAL, MEDICAL, OR SURGICAL BENEFITS
 TO INDIVIDUALS OR GROUPS  ON  AN  EXPENSE-INCURRED  BASIS  UNDER  HEALTH
 INSURANCE  POLICIES  OR  CONTRACTS  THAT ARE ISSUED OR DELIVERED IN THIS
 STATE.
   (II) MANAGED CARE ORGANIZATIONS AS DEFINED AND LICENSED BY  STATE  LAW
 THAT  PROVIDE  HOSPITAL,  MEDICAL OR SURGICAL BENEFITS TO INDIVIDUALS OR
 GROUPS UNDER CONTRACTS THAT ARE ISSUED OR DELIVERED IN THIS STATE.
   (C) AN ENTITY SUBJECT TO THIS PARAGRAPH  SHALL  PROVIDE  COVERAGE  FOR
 HEARING  AIDS FOR PATIENTS WHO ARE COVERED UNDER A POLICY OR CONTRACT OF
 INSURANCE IF THE HEARING AIDS ARE FITTED AND  DISPENSED  BY  A  LICENSED
 AUDIOLOGIST  CERTIFIED  BY  THE AMERICAN SPEECH-LANGUAGE-HEARING ASSOCI-
 ATION FOLLOWING MEDICAL CLEARANCE BY A PHYSICIAN  LICENSED  TO  PRACTICE
 MEDICINE AND AN AUDIOLOGICAL EVALUATION MEDICALLY APPROPRIATE TO THE AGE
 OF THE CHILD, PROVIDED:
   (I)  AN ENTITY SUBJECT TO THIS PARAGRAPH MAY LIMIT THE BENEFIT PAYABLE
 UNDER THIS PARAGRAPH TO THREE THOUSAND DOLLARS PER HEARING AID FOR  EACH
 HEARING-IMPAIRED EAR EVERY TWENTY-FOUR MONTHS.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD05146-03-9

 S. 5495                             2
 
   (II)  AN  INSURED OR ENROLLED INDIVIDUAL MAY CHOOSE A HEARING AID THAT
 IS PRICED HIGHER THAN THE BENEFIT PAYABLE UNDER THIS PARAGRAPH  AND  MAY
 PAY  THE DIFFERENCE BETWEEN THE PRICE OF THE HEARING AID AND THE BENEFIT
 PAYABLE UNDER THIS PARAGRAPH WITHOUT FINANCIAL OR CONTRACTUAL PENALTY TO
 THE PROVIDER OF THE HEARING AID.
   (III)  IN  THE  CASE  OF A HEALTH INSURER OR MANAGED CARE ORGANIZATION
 THAT ADMINISTERS  BENEFITS  ACCORDING  TO  CONTRACTS  WITH  HEALTH  CARE
 PROVIDERS,  HEARING  AIDS  COVERED  PURSUANT  TO THIS PARAGRAPH SHALL BE
 OBTAINED FROM HEALTH CARE PROVIDERS CONTRACTED WITH THE  HEALTH  INSURER
 OR  MANAGED  CARE  ORGANIZATION.  SUCH PROVIDERS SHALL BE SUBJECT TO THE
 SAME CONTRACTING AND CREDENTIALING  REQUIREMENTS  THAT  APPLY  TO  OTHER
 CONTRACTED HEALTH CARE PROVIDERS.
   (D)  THIS  PARAGRAPH  DOES  NOT  PROHIBIT  AN  ENTITY  SUBJECT  TO THE
 PROVISIONS OF THIS PARAGRAPH FROM PROVIDING COVERAGE THAT IS GREATER  OR
 MORE  FAVORABLE  TO  AN INSURED OR ENROLLED INDIVIDUAL THAN THE COVERAGE
 REQUIRED UNDER THIS PARAGRAPH.
   (E) THE PROVISIONS OF THIS PARAGRAPH SHALL APPLY TO  ANY  NEW  POLICY,
 CONTRACT, PROGRAM, OR PLAN ISSUED BY AN ENTITY SUBJECT TO THE PROVISIONS
 OF  THIS  PARAGRAPH  ON OR AFTER JANUARY FIRST, TWO THOUSAND TWENTY-ONE.
 ANY SUCH POLICY, CONTRACT, PROGRAM OR PLAN IN EFFECT  PRIOR  TO  JANUARY
 FIRST,  TWO  THOUSAND TWENTY-ONE SHALL CONVERT TO THE PROVISIONS OF THIS
 PARAGRAPH ON OR BEFORE THE RENEWAL DATE THEREOF BUT IN  NO  EVENT  LATER
 THAN  JANUARY FIRST, TWO THOUSAND TWENTY-ONE. ANY POLICY AFFECTED BY THE
 PROVISIONS OF THIS PARAGRAPH SHALL APPLY TO AN  INSURED  OR  PARTICIPANT
 UNDER SUCH POLICY, CONTRACT, PROGRAM, OR PLAN WHETHER OR NOT THE HEARING
 IMPAIRMENT IS A PRE-EXISTING CONDITION OF THE INSURED OR PARTICIPANT.
   §  2.  Section  3221  of  the insurance law is amended by adding a new
 subsection (u) to read as follows:
   (U) (1) AS USED IN THIS SUBSECTION, "HEARING AID" SHALL  MEAN  A  NON-
 DISPOSABLE DEVICE THAT IS OF A DESIGN AND CIRCUITRY TO OPTIMIZE AUDITION
 AND  LISTENING  SKILLS  IN THE ENVIRONMENT COMMONLY EXPERIENCED BY CHIL-
 DREN.
   (2) THIS SUBSECTION SHALL APPLY TO THE FOLLOWING ENTITIES:
   (A) INSURERS AND NONPROFIT HEALTH SERVICE PLANS, INCLUDING THE  OFFICE
 OF  GROUP BENEFITS, THAT PROVIDE HOSPITAL, MEDICAL, OR SURGICAL BENEFITS
 TO INDIVIDUALS OR GROUPS  ON  AN  EXPENSE-INCURRED  BASIS  UNDER  HEALTH
 INSURANCE  POLICIES  OR  CONTRACTS  THAT ARE ISSUED OR DELIVERED IN THIS
 STATE.
   (B) MANAGED CARE ORGANIZATIONS AS DEFINED AND LICENSED  BY  STATE  LAW
 THAT  PROVIDE  HOSPITAL,  MEDICAL OR SURGICAL BENEFITS TO INDIVIDUALS OR
 GROUPS UNDER CONTRACTS THAT ARE ISSUED OR DELIVERED IN THIS STATE.
   (3) AN ENTITY SUBJECT TO THIS SUBSECTION SHALL  PROVIDE  COVERAGE  FOR
 HEARING  AIDS FOR PATIENTS WHO ARE COVERED UNDER A POLICY OR CONTRACT OF
 INSURANCE IF THE HEARING AIDS ARE FITTED AND  DISPENSED  BY  A  LICENSED
 AUDIOLOGIST  CERTIFIED  BY  THE AMERICAN SPEECH-LANGUAGE-HEARING ASSOCI-
 ATION FOLLOWING MEDICAL CLEARANCE BY A PHYSICIAN  LICENSED  TO  PRACTICE
 MEDICINE AND AN AUDIOLOGICAL EVALUATION MEDICALLY APPROPRIATE TO THE AGE
 OF THE CHILD, PROVIDED:
   (A) AN ENTITY SUBJECT TO THIS SUBSECTION MAY LIMIT THE BENEFIT PAYABLE
 UNDER THIS SUBSECTION TO THREE THOUSAND DOLLARS PER HEARING AID FOR EACH
 HEARING-IMPAIRED EAR EVERY TWENTY-FOUR MONTHS.
   (B) AN INSURED OR ENROLLED INDIVIDUAL MAY CHOOSE A HEARING AID THAT IS
 PRICED HIGHER THAN THE BENEFIT PAYABLE UNDER THIS SUBSECTION AND MAY PAY
 THE  DIFFERENCE  BETWEEN  THE  PRICE  OF THE HEARING AID AND THE BENEFIT
 PAYABLY UNDER THIS SUBSECTION WITHOUT FINANCIAL OR  CONTRACTUAL  PENALTY
 TO THE PROVIDER OF THE HEARING AID.

 S. 5495                             3
 
   (C)  IN THE CASE OF A HEALTH INSURER OR MANAGED CARE ORGANIZATION THAT
 ADMINISTERS BENEFITS ACCORDING TO CONTRACTS WITH HEALTH CARE  PROVIDERS,
 HEARING  AIDS COVERED PURSUANT TO THIS SUBSECTION SHALL BE OBTAINED FROM
 HEALTH CARE PROVIDERS CONTRACTED WITH   THE HEALTH  INSURER  OR  MANAGED
 CARE ORGANIZATION. SUCH PROVIDERS SHALL BE SUBJECT TO THE SAME CONTRACT-
 ING AND CREDENTIALING REQUIREMENTS THAT APPLY TO OTHER CONTRACTED HEALTH
 CARE PROVIDERS.
   (4)  THIS  SUBSECTION  DOES  NOT  PROHIBIT  AN  ENTITY  SUBJECT TO THE
 PROVISIONS OF THIS SUBSECTION FROM PROVIDING COVERAGE THAT IS GREATER OR
 MORE FAVORABLE TO AN INSURED OR ENROLLED INDIVIDUAL  THAN  THE  COVERAGE
 REQUIRED UNDER THIS SUBSECTION.
   (5)  THE  PROVISIONS OF THIS SUBSECTION SHALL APPLY TO ANY NEW POLICY,
 CONTRACT, PROGRAM, OR PLAN ISSUED BY AN ENTITY SUBJECT TO THE PROVISIONS
 OF THIS SUBSECTION ON OR AFTER JANUARY FIRST, TWO  THOUSAND  TWENTY-ONE.
 ANY  SUCH  POLICY,  CONTRACT, PROGRAM OR PLAN IN EFFECT PRIOR TO JANUARY
 FIRST, TWO THOUSAND TWENTY-ONE SHALL CONVERT TO THE PROVISIONS  OF  THIS
 SUBSECTION  ON  OR BEFORE THE RENEWAL DATE THEREOF BUT IN NO EVENT LATER
 THAN JANUARY FIRST, TWO THOUSAND TWENTY-ONE. ANY POLICY AFFECTED BY  THE
 PROVISIONS  OF  THIS SUBSECTION SHALL APPLY TO AN INSURED OR PARTICIPANT
 UNDER SUCH POLICY, CONTRACT, PROGRAM, OR PLAN WHETHER OR NOT THE HEARING
 IMPAIRMENT IS A PRE-EXISTING CONDITION OF THE INSURED OR PARTICIPANT.
   § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (ss) to read as follows:
   (SS)(1)  AS  USED  IN THIS SUBSECTION, "HEARING AID" SHALL MEAN A NON-
 DISPOSABLE DEVICE THAT IS OF A DESIGN AND CIRCUITRY TO OPTIMIZE AUDITION
 AND LISTENING SKILLS IN THE ENVIRONMENT COMMONLY  EXPERIENCED  BY  CHIL-
 DREN.
   (2) THIS SUBSECTION SHALL APPLY TO THE FOLLOWING ENTITIES:
   (A)  INSURERS AND NONPROFIT HEALTH SERVICE PLANS, INCLUDING THE OFFICE
 OF GROUP BENEFITS, THAT PROVIDE HOSPITAL, MEDICAL, OR SURGICAL  BENEFITS
 TO  INDIVIDUALS  OR  GROUPS  ON  AN  EXPENSE-INCURRED BASIS UNDER HEALTH
 INSURANCE POLICIES OR CONTRACTS THAT ARE ISSUED  OR  DELIVERED  IN  THIS
 STATE.
   (B)  MANAGED  CARE  ORGANIZATIONS AS DEFINED AND LICENSED BY STATE LAW
 THAT PROVIDE HOSPITAL, MEDICAL OR SURGICAL BENEFITS  TO  INDIVIDUALS  OR
 GROUPS UNDER CONTRACTS THAT ARE ISSUED OR DELIVERED IN THIS STATE.
   (3)  AN  ENTITY  SUBJECT TO THIS SUBSECTION SHALL PROVIDE COVERAGE FOR
 HEARING AIDS FOR PATIENTS WHO ARE COVERED UNDER A POLICY OR CONTRACT  OF
 INSURANCE  IF  THE  HEARING  AIDS ARE FITTED AND DISPENSED BY A LICENSED
 AUDIOLOGIST CERTIFIED BY THE  AMERICAN  SPEECH-LANGUAGE-HEARING  ASSOCI-
 ATION  FOLLOWING  MEDICAL  CLEARANCE BY A PHYSICIAN LICENSED TO PRACTICE
 MEDICINE AND AN AUDIOLOGICAL EVALUATION MEDICALLY APPROPRIATE TO THE AGE
 OF THE CHILD, PROVIDED:
   (A) AN ENTITY SUBJECT TO THIS SUBSECTION MAY LIMIT THE BENEFIT PAYABLE
 UNDER THIS SUBSECTION TO THREE THOUSAND DOLLARS PER HEARING AID FOR EACH
 HEARING-IMPAIRED EAR EVERY TWENTY-FOUR MONTHS.
   (B) AN INSURED OR ENROLLED INDIVIDUAL MAY CHOOSE A HEARING AID THAT IS
 PRICED  HIGHER THEN THE BENEFIT PAYABLE UNDER HIS SUBSECTION AND MAY PAY
 THE DIFFERENCE BETWEEN THE PRICE OF THE  HEARING  AID  AND  THE  BENEFIT
 PAYABLE  UNDER  THIS SUBSECTION WITHOUT FINANCIAL OR CONTRACTUAL PENALTY
 TO THE PROVIDER OF THE HEARING AID.
   (C) IN THE CASE OF THE HEALTH INSURER  OR  MANAGED  CARE  ORGANIZATION
 THAT  ADMINISTERS  BENEFITS  ACCORDING  TO  CONTRACTS  WITH  HEALTH CARE
 PROVIDERS, HEARING AIDS COVERED PURSUANT TO  THIS  SUBSECTION  SHALL  BE
 OBTAINED  FROM  HEALTH CARE PROVIDERS CONTRACTED WITH THE HEALTH INSURER
 OR MANAGED CARE ORGANIZATION. SUCH PROVIDERS SHALL  BE  SUBJECT  TO  THE

 S. 5495                             4
 
 SAME  CONTRACTING  AND  CREDENTIALING  REQUIREMENTS  THAT APPLY TO OTHER
 CONTRACTED HEALTH CARE PROVIDERS.
   (4)  THIS  SUBSECTION  DOES  NOT  PROHIBIT  AN  ENTITY  SUBJECT TO THE
 PROVISIONS OF THIS SUBSECTION FROM PROVIDING COVERAGE THAT IS GREATER OR
 MORE FAVORABLE TO AN INSURED OR ENROLLED INDIVIDUAL  THAN  THE  COVERAGE
 REQUIRED UNDER THIS SUBSECTION.
   (5)  THE  PROVISIONS OF THIS SUBSECTION SHALL APPLY TO ANY NEW POLICY,
 CONTRACT, PROGRAM, OR PLAN ISSUED BY AN ENTITY SUBJECT TO THE PROVISIONS
 OF THIS SUBSECTION ON OR AFTER JANUARY FIRST, TWO  THOUSAND  TWENTY-ONE.
 ANY  SUCH  POLICY,  CONTRACT, PROGRAM OR PLAN IN EFFECT PRIOR TO JANUARY
 FIRST, TWO THOUSAND TWENTY-ONE SHALL CONVERT TO THE PROVISIONS  OF  THIS
 SUBSECTION  ON  OR BEFORE THE RENEWAL DATE THEREOF BUT IN NO EVENT LATER
 THAN JANUARY FIRST, TWO THOUSAND TWENTY-ONE. ANY POLICY AFFECTED BY  THE
 PROVISION  OF  THIS  SUBSECTION SHALL APPLY TO AN INSURED OR PARTICIPANT
 UNDER SUCH POLICY, CONTRACT, PROGRAM, OR PLAN WHETHER OR NOT THE HEARING
 IMPAIRMENT IS A PRE-EXISTING CONDITION OF THE INSURED OR PARTICIPANT.
   § 4. This act shall take effect on the ninetieth day  after  it  shall
 have become a law. Effective immediately, the addition, amendment and/or
 repeal  of  any  rule  or regulation necessary for the implementation of
 this act on its effective date are authorized to be made  and  completed
 on or before such date.