Bill Text: IL SB0071 | 2011-2012 | 97th General Assembly | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Amends the Illinois Insurance Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to require coverage for hearing instruments and related services for all individuals when a hearing care professional prescribes a hearing instrument. Provides that an insurer shall provide coverage for up to $2,500 per hearing aid per insured's hearing impaired ear subject to certain restrictions. Provides that an insurer shall not be required to pay a claim if the insured filed such a claim 36 months prior to the date of filing the claim with the insurer and the claim was paid by any insurer. Effective immediately.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2013-01-08 - Session Sine Die [SB0071 Detail]
Download: Illinois-2011-SB0071-Amended.html
Bill Title: Amends the Illinois Insurance Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to require coverage for hearing instruments and related services for all individuals when a hearing care professional prescribes a hearing instrument. Provides that an insurer shall provide coverage for up to $2,500 per hearing aid per insured's hearing impaired ear subject to certain restrictions. Provides that an insurer shall not be required to pay a claim if the insured filed such a claim 36 months prior to the date of filing the claim with the insurer and the claim was paid by any insurer. Effective immediately.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2013-01-08 - Session Sine Die [SB0071 Detail]
Download: Illinois-2011-SB0071-Amended.html
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1 | AMENDMENT TO SENATE BILL 71
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2 | AMENDMENT NO. ______. Amend Senate Bill 71 by replacing | ||||||
3 | line 6 on page 1 through line 6 on page 3 with the following:
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4 | "(215 ILCS 5/356z.19 new) | ||||||
5 | Sec. 356z.19. Hearing aid coverage offer. | ||||||
6 | (a) As used in this Section: | ||||||
7 | "Audiological services" means those services medically | ||||||
8 | necessary pursuant to accepted professional medical or | ||||||
9 | audiological standards to assess, select, and adjust or fit | ||||||
10 | the hearing instrument to ensure optimal performance, | ||||||
11 | including, but not limited to, audiological exams, | ||||||
12 | replacement ear molds, and repairs to the hearing | ||||||
13 | instrument. | ||||||
14 | "Hearing aid" means any wearable, non-disposable | ||||||
15 | instrument or device designed to aid or compensate for | ||||||
16 | impaired human hearing in cases where functional ability | ||||||
17 | cannot be restored either medically or surgically and any |
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1 | parts, attachments, or accessories for the instrument or | ||||||
2 | device, including an ear mold but excluding batteries and | ||||||
3 | cords. | ||||||
4 | (b) On or after the effective date of this Section, every | ||||||
5 | insurer that amends, delivers, issues, or renews group accident | ||||||
6 | and health policies providing coverage for hospital or medical | ||||||
7 | treatment or services on an expense-incurred basis shall offer, | ||||||
8 | for an additional premium and subject to the insurer's standard | ||||||
9 | of insurability, optional coverage for the reasonable and | ||||||
10 | necessary medical treatment for audiological services and | ||||||
11 | hearing aids. This coverage shall only apply to hearing aids | ||||||
12 | that are prescribed, filled, and dispensed by a licensed | ||||||
13 | audiologist or a licensed physician. | ||||||
14 | (c) Coverage provided under this Section may be subject to | ||||||
15 | all applicable co-payments, co-insurance, deductibles, and
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16 | out-of-pocket limits, for up to $2,500 per hearing aid per | ||||||
17 | insured's hearing impaired ear subject to the following
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18 | restrictions: | ||||||
19 | (1) for all insured individuals, hearing aids may be
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20 | replaced up to once every 38 months as prescribed and
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21 | dispensed by a licensed audiologist or licensed physician; | ||||||
22 | (2) for all insured individuals, any hearing aid may be
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23 | replaced at any time regardless of the restrictions of item | ||||||
24 | (1) of this subsection (c) if there is a significant change | ||||||
25 | in the insured individual's hearing status; such | ||||||
26 | significant change is defined as a change of 10 decibels HL |
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1 | on the 3-frequency pure-tone average (500 Hz, 1000 Hz, and | ||||||
2 | 2000 Hz) on a valid audiogram provided by a licensed | ||||||
3 | audiologist or licensed physician; | ||||||
4 | (3) for children up to 2 years of age, additional ear | ||||||
5 | molds may be replaced up to 4 times per year; and | ||||||
6 | (4) for all insured individuals, audiological services | ||||||
7 | shall be covered at all times when prescribed by a licensed | ||||||
8 | audiologist or licensed physician. | ||||||
9 | (d) The coverage required by this Section shall be subject
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10 | to other general exclusions and limitations of the policy,
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11 | including coordination of benefits, participating provider
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12 | requirements, restrictions on services provided by family or | ||||||
13 | household members, utilization review of health care services,
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14 | including review of medical necessity, case management,
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15 | experimental and investigational treatments, and other
managed | ||||||
16 | care provisions. ".
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