Senate Bill 2584

AN ACT TO REQUIRE CERTAIN INSURERS AND NONPROFIT HEALTH SERVICE PLANS TO PROVIDE COVERAGE OF HEARING AIDS; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. (1) As used in this act, "hearing aid" shall mean a nondisposible device that is of a design and circuitry to optimize audition and listening skills in the environment commonly experienced by children.

(2) As used in this act, "medically appropriate" shall mean that medical or surgical correction of the hearing loss has been ruled out by a licensed physician.

(3) As used in this act, "audiologically appropriate" shall mean based on the prevailing standards of the practice of audiology. Audiologically appropriate would include physiologic technologies such as Auditory Brainstem Response (ABR) and otoacoustic emissions (OAE). Protocols may be updated as new physiologic technologies or improvements to existing physiologic technologies that would substantially enhance hearing assessment are developed.

(4) As used in this act, "dependent" in relation to an insured shall mean a child who is a dependent of the employee and less than twenty-one (21) years of age or older if so defined by employee's insurance plan.

(5) This act 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.

(6) (a) An entity subject to this act shall provide coverage for hearing aids and medically/audiologically appropriate testing necessary for evaluation and fitting of a child considered a dependent who is covered under a policy or contract of insurance if the hearing aids are fitted and dispensed by a licensed professional following medical clearance, as required by law, by a physician licensed to practice medicine.

(b) An entity subject to this act may limit the benefit payable under paragraph (a) of this subsection to One Thousand Five Hundred Dollars ($1,500.00) per hearing aid for each hearing-impaired ear every thirty-six (36) months.

(c) An entity subject to this act will provide for up to four (4) additional ear molds per year for children up to two (2) years of age.

(d) 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 payable under this subsection without financial or contractual penalty to the provider of the hearing aid.

(e) 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 act 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.

(7) This act does not prohibit an entity subject to the provisions of this act from providing coverage that is greater or more favorable to an insured or enrolled individual than the coverage required under this act.

SECTION 2. The provisions of this act shall take effect and be in force from and after July 1, 2012, and shall apply to any new policy, contract, program or plan issued by an entity subject to the provisions of this act on or after July 1, 2012. Any such policy, contract, program or plan in effect prior to July 1, 2012, shall convert to the provisions of this act on or before the renewal date thereof, but in no event later than January 1, 2014. Any policy affected by the provisions of this act shall apply to an insured or participant under such policy, contract, program or plan whether or not the hearing impairment is a preexisting condition of the insured or participant.