HB 85
Page 1
AN ACT
RELATING TO INSURANCE; REQUIRING INSURANCE COVERAGE FOR
HEARING AIDS FOR ELIGIBLE CHILDREN.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
Section 1. A new section of the Health Care Purchasing
Act is enacted to read:
"HEARING AID COVERAGE FOR CHILDREN REQUIRED.--
A. Group health care coverage, including any form
of self-insurance, offered, issued or renewed under the Health
Care Purchasing Act shall provide coverage for a hearing aid
and any related service for the full cost of one hearing aid
per hearing-impaired ear up to two thousand two hundred
dollars ($2,200) every thirty-six months for hearing aids for
insured children under eighteen years of age or under twenty-
one years of age if still attending high school. The insured
may choose a higher priced hearing aid and may pay the
difference in cost above the two-thousand-two-hundred-dollar
($2,200) limit as provided in this subsection without
financial or contractual penalty to the insured or to the
provider of the hearing aids.
B. Each insurer that delivers, issues for delivery
or renews under the Health Care Purchasing Act any group
health care coverage, including any form of self-insurance,
may make available to the policyholder the option of
pg_0002
HB 85
Page 2
purchasing additional hearing aid coverage that exceeds the
services described in this section.
C. Hearing aid coverage offered shall include
fitting and dispensing services, including providing ear molds
as necessary to maintain optimal fit, provided by an
audiologist, a hearing aid dispenser or a physician, licensed
in New Mexico.
D. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
E. Coverage for hearing aids may be subject to
deductibles and coinsurance consistent with those imposed on
other benefits under the same group health care coverage,
including any form of self-insurance.
F. For the purposes of this section, "hearing aid"
means durable medical equipment that is of a design and
circuitry to optimize audibility and listening skills in the
environment commonly experienced by children."
Section 2. A new section of the New Mexico Insurance
Code, Section 59A-22-34.5 NMSA 1978, is enacted to read:
"59A-22-34.5. HEARING AID COVERAGE FOR CHILDREN
REQUIRED.--
A. An individual or group health insurance policy,
health care plan or certificate of health insurance that is
delivered, issued for delivery or renewed in this state shall
pg_0003
HB 85
Page 3
provide coverage for a hearing aid and any related service for
the full cost of one hearing aid per hearing-impaired ear up
to two thousand two hundred dollars ($2,200) every thirty-six
months for hearing aids for insured children under eighteen
years of age or under twenty-one years of age if still
attending high school. The insured may choose a higher priced
hearing aid and may pay the difference in cost above the two-
thousand-two-hundred-dollar ($2,200) limit as provided in this
subsection without financial or contractual penalty to the
insured or to the provider of the hearing aid.
B. An insurer that delivers, issues for delivery
or renews in this state an individual or group health
insurance policy, health care plan or certificate of health
insurance may make available to the policyholder the option of
purchasing additional hearing aid coverage that exceeds the
services described in this section.
C. Hearing aid coverage offered shall include
fitting and dispensing services, including providing ear molds
as necessary to maintain optimal fit, provided by an
audiologist, a hearing aid dispenser or a physician, licensed
in New Mexico.
D. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
E. Coverage for hearing aids may be subject to
pg_0004
HB 85
Page 4
deductibles and coinsurance consistent with those imposed on
other benefits under the same policy, plan or certificate.
F. For the purposes of this section, "hearing aid"
means durable medical equipment that is of a design and
circuitry to optimize audibility and listening skills in the
environment commonly experienced by children."
Section 3. A new section of the New Mexico Insurance
Code, Section 59A-23-7.6 NMSA 1978, is enacted to read:
"59A-23-7.6. HEARING AID COVERAGE FOR CHILDREN
REQUIRED.--
A. A blanket or group health insurance policy,
health care plan or certificate of health insurance that is
delivered, issued for delivery or renewed in this state shall
provide coverage for a hearing aid and any related service for
the full cost of one hearing aid per hearing-impaired ear up
to two thousand two hundred dollars ($2,200) every thirty-six
months for hearing aids for insured children under eighteen
years of age or under twenty-one years of age if still
attending high school. The insured may choose a higher priced
hearing aid and may pay the difference in cost above the two-
thousand-two-hundred-dollar ($2,200) limit as provided in this
subsection without financial or contractual penalty to the
insured or to the provider of the hearing aid.
B. An insurer that delivers, issues for delivery
or renews in this state a blanket or group health insurance
pg_0005
HB 85
Page 5
policy, health care plan or certificate of health insurance
may make available to the policyholder the option of
purchasing additional hearing aid coverage that exceeds the
services described in this section.
C. Hearing aid coverage offered shall include
fitting and dispensing services, including providing ear molds
as necessary to maintain optimal fit, provided by an
audiologist, a hearing aid dispenser or a physician, licensed
in New Mexico.
D. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
E. Coverage for hearing aids may be subject to
deductibles and coinsurance consistent with those imposed on
other benefits under the same policy, plan or certificate.
F. For the purposes of this section, "hearing aid"
means durable medical equipment that is of a design and
circuitry to optimize audibility and listening skills in the
environment commonly experienced by children."
Section 4. A new section of the New Mexico Insurance
Code, Section 59A-46-38.5 NMSA 1978, is enacted to read:
"59A-46-38.5. HEARING AID COVERAGE FOR CHILDREN
REQUIRED.--
A. An individual or group health maintenance
organization contract delivered, issued for delivery or
pg_0006
HB 85
Page 6
renewed in this state shall provide coverage for a hearing aid
and any related service for the full cost of one hearing aid
per hearing-impaired ear up to two thousand two hundred
dollars ($2,200) every thirty-six months for hearing aids for
insured children under eighteen years of age or under twenty-
one years of age if still attending high school. The insured
may choose a higher priced hearing aid and may pay the
difference in cost above the two-thousand-two-hundred-dollar
($2,200) limit as provided in this subsection without
financial or contractual penalty to the insured or to the
provider of the hearing aid.
B. An insurer that delivers, issues for delivery
or renews in this state an individual or group health
maintenance organization contract may make available to the
policyholder the option of purchasing additional hearing aid
coverage that exceeds the services described in this section.
C. Hearing aid coverage offered shall include
fitting and dispensing services, including providing ear molds
as necessary to maintain optimal fit, provided by an
audiologist, a hearing aid dispenser or a physician, licensed
in New Mexico. A health maintenance organization has the
discretion to determine the provider of hearing aids with
which it contracts. Nothing in this section shall be
construed to preclude a health maintenance organization from
conducting medical necessity or utilization review for hearing
pg_0007
HB 85
Page 7
aids and related services.
D. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
E. Coverage for hearing aids may be subject to
deductibles and coinsurance consistent with those imposed on
other benefits under the same policy, plan or certificate.
F. For the purposes of this section, "hearing aid"
means durable medical equipment that is of a design and
circuitry to optimize audibility and listening skills in the
environment commonly experienced by children."
Section 5. A new section of the New Mexico Insurance
Code, Section 59A-47-37.1 NMSA 1978, is enacted to read:
"59A-47-37.1. HEARING AID COVERAGE FOR CHILDREN
REQUIRED.--
A. An individual or group health insurance policy,
health care plan or certificate of health insurance delivered
or issued for delivery in this state shall provide coverage
for a hearing aid and any related service for the full cost of
one hearing aid per hearing-impaired ear up to two thousand
two hundred dollars ($2,200) every thirty-six months for
hearing aids for insured children under eighteen years of age
or under twenty-one years of age if still attending high
school. The insured may choose a higher priced hearing aid
and may pay the difference in cost above the two-thousand-two-
pg_0008
HB 85
Page 8
hundred-dollar ($2,200) limit as provided in this subsection
without financial or contractual penalty to the insured or to
the provider of the hearing aid.
B. An insurer that delivers, issues for delivery
or renews in this state an individual or group health
insurance policy, health care plan or certificate of health
insurance may make available to the policyholder the option of
purchasing additional hearing aid coverage that exceeds the
services described in this section.
C. Hearing aid coverage offered shall include
fitting and dispensing services, including providing ear molds
as necessary to maintain optimal fit, provided by an
audiologist, a hearing aid dispenser or a physician, licensed
in New Mexico.
D. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
E. Coverage for hearing aids may be subject to
deductibles and coinsurance consistent with those imposed on
other benefits under the same policy, plan or certificate.
F. For the purposes of this section, "hearing aid"
means durable medical equipment that is of a design and
circuitry to optimize audibility and listening skills in the
environment commonly experienced by children."
Section 6. EFFECTIVE DATE.--The effective date of the
pg_0009
provisions of this act is July 1, 2007.
HB 85
Page 9